Healthcare Provider Details

I. General information

NPI: 1932904604
Provider Name (Legal Business Name): RAUL CAYETANO HUARCAYA TUMBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 S MARYLAND PKWY # 1
LAS VEGAS NV
89104-3106
US

IV. Provider business mailing address

10265 MOTH ORCHID CT
LAS VEGAS NV
89183-4039
US

V. Phone/Fax

Practice location:
  • Phone: 702-331-3650
  • Fax:
Mailing address:
  • Phone: 702-460-7449
  • 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: