Healthcare Provider Details

I. General information

NPI: 1639728785
Provider Name (Legal Business Name): TERESA JUAREZ-SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 RANCHO LN #25
LAS VEGAS NV
89106
US

IV. Provider business mailing address

4650 E. CAREY AVE. TRLR 177
LAS VEGAS NV
89115-4423
US

V. Phone/Fax

Practice location:
  • Phone: 702-822-2655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: