1053439315 NPI number — MRS. JOSEFINA NATERA BS CADC INTERN LBSW

Table of content: (NPI 1629325691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053439315 NPI number — MRS. JOSEFINA NATERA BS CADC INTERN LBSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NATERA
Provider First Name:
JOSEFINA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BS CADC INTERN LBSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODRIGUEZ
Provider Other First Name:
JOSEFINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BS CADC INTERN LBSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053439315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 W CHARLESTON BLVD
Provider Second Line Business Mailing Address:
215
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89102-2325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-671-2355
Provider Business Mailing Address Fax Number:
702-382-5388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6375 W CHARLESTON BLVD
Provider Second Line Business Practice Location Address:
A-172
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-877-0684
Provider Business Practice Location Address Fax Number:
702-877-2108
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  3891-1 CADC INTERN , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 3891-1 CADC INTERN , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3891-1 . This is a "LICENSE CADC INTERN" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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