Healthcare Provider Details

I. General information

NPI: 1720533995
Provider Name (Legal Business Name): MARIBEL SAN BUENAVENTURA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 TOSSA DE MAR AVE
HENDERSON NV
89002-6535
US

IV. Provider business mailing address

774 TOSSA DE MAR AVE
HENDERSON NV
89002-6535
US

V. Phone/Fax

Practice location:
  • Phone: 702-750-9259
  • Fax: 702-750-9259
Mailing address:
  • Phone: 702-750-9259
  • Fax: 702-750-9259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN73981
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: