Provider Demographics
NPI:1962253542
Name:CRUZ, ANTHONY RA
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:RA
Last Name:CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 E DESERT COVE AVE UNIT 350
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-7403
Mailing Address - Country:US
Mailing Address - Phone:772-713-5274
Mailing Address - Fax:
Practice Address - Street 1:4925 E DESERT COVE AVE UNIT 350
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-7403
Practice Address - Country:US
Practice Address - Phone:772-713-5274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician