Healthcare Provider Details

I. General information

NPI: 1811592728
Provider Name (Legal Business Name): MARIA-LUZ HIZON CAUDAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 E LAKE MEAD BLVD
NORTH LAS VEGAS NV
89030-7135
US

IV. Provider business mailing address

2011 E LAKE MEAD BLVD
NORTH LAS VEGAS NV
89030-7135
US

V. Phone/Fax

Practice location:
  • Phone: 702-649-1991
  • Fax: 702-649-8020
Mailing address:
  • Phone: 702-649-1991
  • Fax: 702-649-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16627
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: