Healthcare Provider Details

I. General information

NPI: 1427856418
Provider Name (Legal Business Name): LUISA MALDONADO CHW1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUISA FERNANDA SOLIS

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 N MARTIN LUTHER BOULEVARD SUITE 110
NORTH LAS VEGAS NV
89032
US

IV. Provider business mailing address

PO BOX 400845
LAS VEGAS NV
89140-0845
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-0909
  • Fax: 702-724-1978
Mailing address:
  • Phone: 702-731-0909
  • Fax: 702-724-1978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW1-6021
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: