Healthcare Provider Details

I. General information

NPI: 1215749346
Provider Name (Legal Business Name): IDANIA ROSA LAZO-DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 E EASTERN AVE
LAS VEGAS NV
89104
US

IV. Provider business mailing address

2051 E EASTERN AVE
LAS VEGAS NV
89104
US

V. Phone/Fax

Practice location:
  • Phone: 702-207-0842
  • Fax: 702-207-0357
Mailing address:
  • Phone: 702-207-0842
  • Fax: 702-207-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: