Healthcare Provider Details

I. General information

NPI: 1104127976
Provider Name (Legal Business Name): LUZ ADRIANA NEVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 S EASTERN AVE 202
LAS VEGAS NV
89119-6137
US

IV. Provider business mailing address

4660 S EASTERN AVE 104A
LAS VEGAS NV
89119-6137
US

V. Phone/Fax

Practice location:
  • Phone: 702-451-7542
  • Fax: 702-450-4239
Mailing address:
  • Phone: 702-451-7542
  • Fax: 702-450-4239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: