Healthcare Provider Details

I. General information

NPI: 1134408032
Provider Name (Legal Business Name): NIKKI JOY ECTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 WARM SPRINGS RD. #1102
HENDERSON NV
89014
US

IV. Provider business mailing address

8620 S EASTERN AVE #16
LAS VEGAS NV
89123-2836
US

V. Phone/Fax

Practice location:
  • Phone: 702-992-0576
  • Fax: 702-992-0391
Mailing address:
  • Phone: 702-992-0576
  • Fax: 702-992-0391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: