Provider Demographics
NPI:1427856418
Name:MALDONADO, LUISA (CHW1)
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:
Credentials:CHW1
Other - Prefix:
Other - First Name:LUISA
Other - Middle Name:FERNANDA
Other - Last Name:SOLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 400845
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-0845
Mailing Address - Country:US
Mailing Address - Phone:702-731-0909
Mailing Address - Fax:702-724-1978
Practice Address - Street 1:3940 N MARTIN LUTHER BOULEVARD
Practice Address - Street 2:SUITE 110
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-731-0909
Practice Address - Fax:702-724-1978
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-6021172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker