Provider Demographics
NPI:1013679091
Name:TOVAR, CRUZ ANTONIO (PHD)
Entity type:Individual
Prefix:DR
First Name:CRUZ
Middle Name:ANTONIO
Last Name:TOVAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1530
Mailing Address - Street 2:
Mailing Address - City:PRESIDIO
Mailing Address - State:TX
Mailing Address - Zip Code:79845-1530
Mailing Address - Country:US
Mailing Address - Phone:915-329-5445
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR BLDG 7500
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4613
Practice Address - Country:US
Practice Address - Phone:915-329-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX36582103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program