Healthcare Provider Details

I. General information

NPI: 1831658830
Provider Name (Legal Business Name): VENESSA TIZNADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 W OAKEY BLVD STE 108A
LAS VEGAS NV
89102-1506
US

IV. Provider business mailing address

201 S 17TH ST
LAS VEGAS NV
89101-5218
US

V. Phone/Fax

Practice location:
  • Phone: 702-906-1999
  • Fax: 702-906-1998
Mailing address:
  • Phone: 702-726-1563
  • 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: