Provider Demographics
NPI:1750163952
Name:SORIA, JUSTIN NOEL CRUZ
Entity type:Individual
Prefix:
First Name:JUSTIN NOEL
Middle Name:CRUZ
Last Name:SORIA
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 1:10631 ALONDRA PEAK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-4649
Mailing Address - Country:US
Mailing Address - Phone:702-417-0460
Mailing Address - Fax:
Practice Address - Street 1:10631 ALONDRA PEAK ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-4649
Practice Address - Country:US
Practice Address - Phone:702-417-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-15271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical