Provider Demographics
NPI:1225825821
Name:ILLAS RODRIGUEZ, MAYLIN
Entity type:Individual
Prefix:
First Name:MAYLIN
Middle Name:
Last Name:ILLAS RODRIGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E FLAMINGO RD APT 2220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-4812
Mailing Address - Country:US
Mailing Address - Phone:725-298-6831
Mailing Address - Fax:
Practice Address - Street 1:325 E FLAMINGO RD APT 2220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-4812
Practice Address - Country:US
Practice Address - Phone:725-298-6831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant