Healthcare Provider Details

I. General information

NPI: 1083194682
Provider Name (Legal Business Name): ADAIRIS SALCEDO LICEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N RAINBOW BLVD
LAS VEGAS NV
89108-4558
US

IV. Provider business mailing address

2701 N RAINBOW BLVD
LAS VEGAS NV
89108-4558
US

V. Phone/Fax

Practice location:
  • Phone: 702-466-6137
  • Fax:
Mailing address:
  • Phone: 702-466-6137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: