Provider Demographics
NPI:1215435490
Name:NAVARRO- VILLARREAL, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NAVARRO- VILLARREAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 S CIMARRON RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2682
Mailing Address - Country:US
Mailing Address - Phone:702-871-0002
Mailing Address - Fax:702-871-0201
Practice Address - Street 1:2701 CLARK TOWERS CT APT 233
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-5878
Practice Address - Country:US
Practice Address - Phone:702-502-6658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$Medicaid