Provider Demographics
NPI:1154976041
Name:MARISCAL OLIVAS, CELENE
Entity type:Individual
Prefix:
First Name:CELENE
Middle Name:
Last Name:MARISCAL OLIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CELENE
Other - Middle Name:
Other - Last Name:MARISCAL OLIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4055 SPENCER STREET
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119
Mailing Address - Country:US
Mailing Address - Phone:702-405-9565
Mailing Address - Fax:702-953-7910
Practice Address - Street 1:4055 SPENCER STREET
Practice Address - Street 2:SUITE 109
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-405-9565
Practice Address - Fax:702-953-7910
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant