Healthcare Provider Details

I. General information

NPI: 1659944239
Provider Name (Legal Business Name): MISS AIMEE NAZARIO-OVALLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 W WASHING AVE #302
LAS VEGAS NV
89128
US

IV. Provider business mailing address

7455 W WASHING AVE #302
LAS VEGAS NV
89128
US

V. Phone/Fax

Practice location:
  • Phone: 281-495-5966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: