Healthcare Provider Details

I. General information

NPI: 1154120459
Provider Name (Legal Business Name): JESSICA RAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W CHARLESTON BLVD
LAS VEGAS NV
89102-2351
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD STE 490
LAS VEGAS NV
89102-2309
US

V. Phone/Fax

Practice location:
  • Phone: 559-577-6834
  • Fax:
Mailing address:
  • Phone: 702-671-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1154120459
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: