Healthcare Provider Details

I. General information

NPI: 1881654093
Provider Name (Legal Business Name): GREATER VEGAS PERSONAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 S JONES BLVD
LAS VEGAS NV
89107-2623
US

IV. Provider business mailing address

336 S JONES BLVD
LAS VEGAS NV
89107-2623
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-8884
  • Fax: 702-735-8886
Mailing address:
  • Phone: 702-735-8884
  • Fax: 702-735-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number132986
License Number StateNV

VIII. Authorized Official

Name: MRS. FABIANA ALFARO
Title or Position: MEMBER
Credential:
Phone: 702-735-8884