Healthcare Provider Details

I. General information

NPI: 1578195558
Provider Name (Legal Business Name): ETH HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 S JONES BLVD STE 130
LAS VEGAS NV
89146-5641
US

IV. Provider business mailing address

7945 SKY BIRCH CT
LAS VEGAS NV
89147-4284
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-0085
  • Fax:
Mailing address:
  • Phone: 702-863-3735
  • Fax:

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: