Healthcare Provider Details

I. General information

NPI: 1417452186
Provider Name (Legal Business Name): ANNA OGECHUKWU OPARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 W FLAMINGO RD
LAS VEGAS NV
89103-2334
US

IV. Provider business mailing address

1304 DOVER GLEN DR
NORTH LAS VEGAS NV
89031-1498
US

V. Phone/Fax

Practice location:
  • Phone: 325-864-5699
  • Fax: 702-323-0898
Mailing address:
  • Phone: 325-864-5699
  • Fax: 702-323-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: