Healthcare Provider Details

I. General information

NPI: 1932846383
Provider Name (Legal Business Name): HILDA JAZMINE TZENDZALIAN-HALLOWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4456 PROSPECT HILL CT
LAS VEGAS NV
89129-3294
US

IV. Provider business mailing address

4456 PROSPECT HILL CT
LAS VEGAS NV
89129-3294
US

V. Phone/Fax

Practice location:
  • Phone: 208-585-8722
  • Fax:
Mailing address:
  • Phone: 208-585-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: