Healthcare Provider Details

I. General information

NPI: 1043740442
Provider Name (Legal Business Name): MR. PAPAREX EDIRIN MINABOWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 06/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 E SAHARA AVE # 108
LAS VEGAS NV
89104-3707
US

IV. Provider business mailing address

11000 S EASTERN AVE APT 1325
HENDERSON NV
89052-2964
US

V. Phone/Fax

Practice location:
  • Phone: 702-822-0447
  • Fax:
Mailing address:
  • Phone: 907-764-1035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberNV20171341089
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: