Provider Demographics
NPI:1215697669
Name:DEBARROS, GLEN NELSON
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:NELSON
Last Name:DEBARROS
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 1:1820 E SAHARA AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3736
Mailing Address - Country:US
Mailing Address - Phone:702-262-1202
Mailing Address - Fax:702-749-6232
Practice Address - Street 1:1820 E SAHARA AVE STE 114
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3736
Practice Address - Country:US
Practice Address - Phone:702-262-1202
Practice Address - Fax:702-749-6232
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant