Healthcare Provider Details

I. General information

NPI: 1972447563
Provider Name (Legal Business Name): JULIO ISLAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 W 4TH ST STE 213
RENO NV
89503-5149
US

IV. Provider business mailing address

6303 PARK PLACE
RENO NV
89523
US

V. Phone/Fax

Practice location:
  • Phone: 530-414-4291
  • Fax:
Mailing address:
  • Phone: 530-414-4291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number897969
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: