Healthcare Provider Details

I. General information

NPI: 1538731971
Provider Name (Legal Business Name): JENET LA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 POLARIS AVE
LAS VEGAS NV
89102-8350
US

IV. Provider business mailing address

3230 POLARIS AVE
LAS VEGAS NV
89102-8350
US

V. Phone/Fax

Practice location:
  • Phone: 702-678-5089
  • Fax:
Mailing address:
  • Phone: 702-678-5089
  • Fax: 702-294-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: