Healthcare Provider Details

I. General information

NPI: 1962282525
Provider Name (Legal Business Name): MARIBEL IRENE SALAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIBEL IRENE SALAS MARIBEL IRENE SALAS

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 09/26/2023
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number2101377248
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: