Provider Demographics
NPI:1437180478
Name:CRUEY, KAREN LEAH (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LEAH
Last Name:CRUEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S FIGUEROA ST STE 3140
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90071-1602
Mailing Address - Country:US
Mailing Address - Phone:702-419-0595
Mailing Address - Fax:702-247-4082
Practice Address - Street 1:2340 PASEO DEL PRADO STE D303
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4342
Practice Address - Country:US
Practice Address - Phone:702-419-0595
Practice Address - Fax:702-247-4802
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC515142084P0800X
NV85062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG65011Medicare UPIN
NV30629Medicare ID - Type UnspecifiedMEDICARE NUMBER