Healthcare Provider Details

I. General information

NPI: 1841005014
Provider Name (Legal Business Name): ANIA ALIAGA MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5322 DEL GADO DR APT 3
LAS VEGAS NV
89103-3566
US

IV. Provider business mailing address

5322 DEL GADO DR APT 3
LAS VEGAS NV
89103-3566
US

V. Phone/Fax

Practice location:
  • Phone: 702-695-4008
  • Fax:
Mailing address:
  • Phone: 702-695-4008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number884289
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number884289
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number884289
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number884289
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: