Provider Demographics
NPI:1316656507
Name:NEYRA, ANGELICA ALIMBOYOGEN
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:ALIMBOYOGEN
Last Name:NEYRA
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 1:1830 E SAHARA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3739
Mailing Address - Country:US
Mailing Address - Phone:702-201-1905
Mailing Address - Fax:702-202-6845
Practice Address - Street 1:1830 E SAHARA AVE STE 204
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3739
Practice Address - Country:US
Practice Address - Phone:702-201-1905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty