Healthcare Provider Details

I. General information

NPI: 1548089766
Provider Name (Legal Business Name): JANELLE ALVAREZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W LAKE MEAD PKWY
HENDERSON NV
89015-7015
US

IV. Provider business mailing address

6355 S BUFFALO DR FL 3
LAS VEGAS NV
89113-2133
US

V. Phone/Fax

Practice location:
  • Phone: 702-565-1007
  • Fax: 702-565-0836
Mailing address:
  • Phone: 702-216-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3142
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: