Healthcare Provider Details

I. General information

NPI: 1568964526
Provider Name (Legal Business Name): PRESENTACION PRISILA CORRAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 STELLA LAKE ST STE 36
LAS VEGAS NV
89106-2144
US

IV. Provider business mailing address

3633 S SANDHILL RD
LAS VEGAS NV
89121-3437
US

V. Phone/Fax

Practice location:
  • Phone: 702-888-1415
  • Fax:
Mailing address:
  • Phone: 702-685-5236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number1401587348
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: