Provider Demographics
NPI:1578016440
Name:CRUZ, JOSUE SEBASTIAN (RBT)
Entity type:Individual
Prefix:
First Name:JOSUE
Middle Name:SEBASTIAN
Last Name:CRUZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 NEIL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6555
Mailing Address - Country:US
Mailing Address - Phone:775-287-1519
Mailing Address - Fax:
Practice Address - Street 1:5250 NEIL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6555
Practice Address - Country:US
Practice Address - Phone:775-287-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-16-24430106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRBT-16-24430OtherNON-MEDICARE