Provider Demographics
NPI:1306580667
Name:CRUZ, JANISHA RYANN
Entity type:Individual
Prefix:
First Name:JANISHA
Middle Name:RYANN
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 SURFBIRD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2255
Mailing Address - Country:US
Mailing Address - Phone:725-259-2695
Mailing Address - Fax:
Practice Address - Street 1:601 S RANCHO DR STE A10
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4898
Practice Address - Country:US
Practice Address - Phone:702-437-4673
Practice Address - Fax:702-438-4673
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2025-01-17
Deactivation Date:2022-06-01
Deactivation Code:
Reactivation Date:2025-01-17
Provider Licenses
StateLicense IDTaxonomies
NV10201-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical