Healthcare Provider Details

I. General information

NPI: 1689975765
Provider Name (Legal Business Name): MS. LLUVIA LANUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 S DURANGO DR STE 207
LAS VEGAS NV
89113-0156
US

IV. Provider business mailing address

1876 GRANEMORE ST
LAS VEGAS NV
89135-3341
US

V. Phone/Fax

Practice location:
  • Phone: 702-650-6508
  • Fax: 702-893-9655
Mailing address:
  • Phone: 702-530-1392
  • Fax:

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: