Healthcare Provider Details

I. General information

NPI: 1134037401
Provider Name (Legal Business Name): STEPHANIE VALLADARES DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 N RAMPART BLVD
LAS VEGAS NV
89128-7640
US

IV. Provider business mailing address

2211 N RAMPART BLVD
LAS VEGAS NV
89128-7640
US

V. Phone/Fax

Practice location:
  • Phone: 702-256-1984
  • Fax:
Mailing address:
  • Phone: 702-256-1984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25271
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: