Healthcare Provider Details

I. General information

NPI: 1316174006
Provider Name (Legal Business Name): MARIA RIZALINA BARLAAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10652 S EASTERN AVE STE A
HENDERSON NV
89052-4953
US

IV. Provider business mailing address

2704 N TENAYA WAY
LAS VEGAS NV
89128-0424
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-2800
  • Fax: 702-476-2040
Mailing address:
  • Phone: 702-877-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN001118
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN50068
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: