Provider Demographics
NPI:1336884907
Name:PAVIA, LIZA SERVIDAD
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:SERVIDAD
Last Name:PAVIA
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 1:700 SARAJANE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1580
Mailing Address - Country:US
Mailing Address - Phone:702-767-6513
Mailing Address - Fax:
Practice Address - Street 1:1775 E TROPICANA AVE STE 16B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6557
Practice Address - Country:US
Practice Address - Phone:702-405-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant