Healthcare Provider Details

I. General information

NPI: 1396225660
Provider Name (Legal Business Name): BRENDA TAMAYO VILLALOBOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6128 W SAHARA AVE
LAS VEGAS NV
89146-3051
US

IV. Provider business mailing address

2400 XENIA AVE
PAHRUMP NV
89048-6161
US

V. Phone/Fax

Practice location:
  • Phone: 702-598-2048
  • Fax: 702-598-2041
Mailing address:
  • Phone: 702-232-2174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: