Healthcare Provider Details

I. General information

NPI: 1083583264
Provider Name (Legal Business Name): ZAILY DIAZ HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 S MARYLAND PKWY
LAS VEGAS NV
89109-2317
US

IV. Provider business mailing address

3186 S MARYLAND PKWY
LAS VEGAS NV
89109-2317
US

V. Phone/Fax

Practice location:
  • Phone: 702-961-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTEMP856761
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: