Healthcare Provider Details

I. General information

NPI: 1225503238
Provider Name (Legal Business Name): HOLLY ABARCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 SHOSHONE LN
HENDERSON NV
89015
US

IV. Provider business mailing address

6128 W SAHARA AVE
LAS VEGAS NV
89146-3051
US

V. Phone/Fax

Practice location:
  • Phone: 702-929-0170
  • Fax:
Mailing address:
  • Phone: 702-598-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: