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General NPI Number Information
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NPI Number | 1215745500
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Entity Type | Individual
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Provider Name | ALYSSA BALTAZAR LONG
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Gender | Female
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 850 MILL ST STE 100
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City | RENO
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State | NV
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Zip | 89502-1463
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Country | US
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Telephone | 702-410-7825
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Fax | 702-946-0409
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Provider Business Mailing Address
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Address Line | 3312 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-1829
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Country | US
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Telephone | 702-410-7825
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Fax | 702-946-0409
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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