Healthcare Provider Details

I. General information

NPI: 1568287100
Provider Name (Legal Business Name): NAOMI NAOMI OLIVA OLIVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 N 11TH ST APT 2
LAS VEGAS NV
89101-2546
US

IV. Provider business mailing address

740 N 11TH ST APT 2
LAS VEGAS NV
89101-2546
US

V. Phone/Fax

Practice location:
  • Phone: 702-604-9662
  • Fax:
Mailing address:
  • Phone: 702-604-9662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number884038
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: