Healthcare Provider Details

I. General information

NPI: 1932063302
Provider Name (Legal Business Name): ALEXA DANIELLE VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3437 GOLDEN SAGE DR
NORTH LAS VEGAS NV
89032-2418
US

IV. Provider business mailing address

3437 GOLDEN SAGE DR
NORTH LAS VEGAS NV
89032-2418
US

V. Phone/Fax

Practice location:
  • Phone: 702-764-9621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number894114
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: