Healthcare Provider Details

I. General information

NPI: 1689161119
Provider Name (Legal Business Name): JAYMIE ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 S DECATUR BLVD STE B6
LAS VEGAS NV
89103-6802
US

IV. Provider business mailing address

2900 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-5014
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-2100
  • Fax:
Mailing address:
  • Phone: 702-357-8811
  • Fax: 702-357-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1914
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: