Healthcare Provider Details

I. General information

NPI: 1639840887
Provider Name (Legal Business Name): DANICA LOSTICA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2887 S MARYLAND PKWY
LAS VEGAS NV
89109-1511
US

IV. Provider business mailing address

2887 S MARYLAND PKWY
LAS VEGAS NV
89109-1511
US

V. Phone/Fax

Practice location:
  • Phone: 702-474-4104
  • Fax:
Mailing address:
  • Phone: 24-744-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number718312
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number851382
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: