Healthcare Provider Details

I. General information

NPI: 1104394436
Provider Name (Legal Business Name): DENISIS VARONA-CHALA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4714 E FLAMINGO RD
LAS VEGAS NV
89121-4709
US

IV. Provider business mailing address

4714 E FLAMINGO RD
LAS VEGAS NV
89121-4709
US

V. Phone/Fax

Practice location:
  • Phone: 702-685-7770
  • Fax:
Mailing address:
  • Phone: 702-685-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: DENISIS VARONA CHALA
Title or Position: OWNER
Credential:
Phone: 702-296-2765