Healthcare Provider Details

I. General information

NPI: 1427772490
Provider Name (Legal Business Name): RAEDELL ARANAS DELEON-VALDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 N TENAYA WAY STE 104
LAS VEGAS NV
89128-0488
US

IV. Provider business mailing address

1546 EMERALD OAKS AVE
HENDERSON NV
89014-2690
US

V. Phone/Fax

Practice location:
  • Phone: 702-805-5678
  • Fax: 702-268-7605
Mailing address:
  • Phone: 702-572-4675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number860222
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number860222
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: