Healthcare Provider Details

I. General information

NPI: 1407332513
Provider Name (Legal Business Name): LUCELIA PUENTE NOA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3529 BOOTH ST
NORTH LAS VEGAS NV
89032-3424
US

IV. Provider business mailing address

3529 BOOTH ST
NORTH LAS VEGAS NV
89032-3424
US

V. Phone/Fax

Practice location:
  • Phone: 702-444-9756
  • Fax:
Mailing address:
  • Phone: 702-444-9756
  • 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: