Healthcare Provider Details

I. General information

NPI: 1720545916
Provider Name (Legal Business Name): NELIA BUENDIA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 VISTA LARGA CIR
RENO NV
89523-1815
US

IV. Provider business mailing address

5325 VISTA LARGA CIR
RENO NV
89523-1815
US

V. Phone/Fax

Practice location:
  • Phone: 775-787-1188
  • Fax: 775-787-1188
Mailing address:
  • Phone: 775-787-1188
  • Fax: 775-787-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberR115348A
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: