1215435490 NPI number — MARIA NAVARRO- VILLARREAL

Table of content: MARIA NAVARRO- VILLARREAL (NPI 1215435490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215435490 NPI number — MARIA NAVARRO- VILLARREAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAVARRO- VILLARREAL
Provider First Name:
MARIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215435490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2575 S CIMARRON RD STE 200A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-2682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-871-0002
Provider Business Mailing Address Fax Number:
702-871-0201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 CLARK TOWERS CT APT 233
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89102-5878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-502-6658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2018

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: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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