Healthcare Provider Details

I. General information

NPI: 1871331918
Provider Name (Legal Business Name): VIRIDIANA SILVA CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 S. EASTERN AVENUE FIRSTMED HEALTH AND WELLNESS CENTER
LAS VEGAS NV
89169
US

IV. Provider business mailing address

8936 SPANISH RIDGE AVENUE ATTN: CREDENTIALING FMHWC
LAS VEGAS NV
89148
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-0909
  • Fax: 702-998-2991
Mailing address:
  • Phone: 702-731-0909
  • Fax: 702-998-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHWI-5793
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: