Healthcare Provider Details

I. General information

NPI: 1871017400
Provider Name (Legal Business Name): JULIA VIVIEN DE JESUS NAVALTA MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA VIVIEN ROXAS DE JESUS APRN, FNP-BC

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6170 N DURANGO DR STE 130
LAS VEGAS NV
89149-3923
US

IV. Provider business mailing address

6355 S BUFFALO DR FL 3
LAS VEGAS NV
89113-2133
US

V. Phone/Fax

Practice location:
  • Phone: 702-940-1550
  • Fax: 702-940-1551
Mailing address:
  • Phone: 702-216-3346
  • Fax: 702-671-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002556
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: