Healthcare Provider Details

I. General information

NPI: 1669106001
Provider Name (Legal Business Name): EDITHA OLOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 SPENCER ST STE 109
LAS VEGAS NV
89119-5250
US

IV. Provider business mailing address

98 S MARTIN L KING BLVD APT 158
LAS VEGAS NV
89106-4317
US

V. Phone/Fax

Practice location:
  • Phone: 702-405-9565
  • Fax:
Mailing address:
  • Phone: 702-937-4315
  • 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: