Healthcare Provider Details

I. General information

NPI: 1922764380
Provider Name (Legal Business Name): LINO NUNEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 RANCHO LN STE 25
LAS VEGAS NV
89106-3806
US

IV. Provider business mailing address

820 RANCHO LN STE 25
LAS VEGAS NV
89106-3806
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: