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NPI Code Detail

MEDICARE: JERRAY REDOR BRACEROS-INOFINADA RN, BSN

MEDICARE: JERRAY REDOR BRACEROS-INOFINADA RN, BSN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse820330NV

General Provider Information

NPI Number : 1528837762
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRAY REDOR BRACEROS-INOFINADA RN, BSN
Provider Business Mailing Address
First Line : 5862 MAGINI AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89141-3918
Country : US
Telephone Number : 808-772-6537
Fax Number :
Provider Business Practice Location Address
First Line : 4040 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0810
Country : US
Telephone Number : 702-463-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2023
Last Update Date : 12/28/2023

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