Healthcare Provider Details

I. General information

NPI: 1902942725
Provider Name (Legal Business Name): ADA IRIS VERA D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 W CHARLESTON BLVD STE 6
LAS VEGAS NV
89102-1940
US

IV. Provider business mailing address

PO BOX 33250
LAS VEGAS NV
89133-3250
US

V. Phone/Fax

Practice location:
  • Phone: 702-878-5252
  • Fax: 702-878-1963
Mailing address:
  • Phone: 702-878-5252
  • Fax: 702-878-1963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0016
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: