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NPI Code Detail

MEDICARE: EDELYN AVELINO PENAFLOR BSN, RN

MEDICARE: EDELYN AVELINO PENAFLOR BSN, RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WG0000XGeneral Practice Registered Nurse838369NV

General Provider Information

NPI Number : 1376313379
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDELYN AVELINO PENAFLOR BSN, RN
Provider Business Mailing Address
First Line : 7979 DIAMOND SKY AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-6269
Country : US
Telephone Number : 562-235-9565
Fax Number :
Provider Business Practice Location Address
First Line : 4040 S EASTERN AVE STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0854
Country : US
Telephone Number : 702-463-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2024
Last Update Date : 01/02/2024

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