John J Cruz
Individual provider Active NPI Peer Specialist · Republic, WA
NPI 1104332170 · NPPES record last updated Dec 28, 2017
Key facts
- NPI
- 1104332170
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- License
- CG60806753 (WA)
- Practice address
- 65 N Keller
Republic, WA 99166-8804 - Phone
- (509) 775-3364
- Fax
- (509) 775-8906
- NPI assigned
- Dec 28, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG60806753 | WA | MD | Peer Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stevens County | Past | Accepting new patients | |
| Stevens County | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | CG60806753 | WA | Yes |
Addresses
Primary practice location
65 N Keller
Republic, WA 99166-8804
Mailing address
165 E Hawthorne Ave
Colville, WA 99114-2629
Phone (509) 684-4597
Other providers in Republic, WA
- Albert David Brauer
- John Joseph Brucklier
- Annette L. Byrd
- Ronald L Casebeer
- Kristi Lee Cassady
- Dan Leland Daily
- Ferry County Counseling Services
- Ferry County Counseling Services
- Ferry County Emergency Medical Services District 1
- Ferry County Hospital District #1
All providers in Republic, WA · Peer Specialist in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.