Provider Demographics
NPI:1528884673
Name:OFARRILL, PALOMA
Entity type:Individual
Prefix:
First Name:PALOMA
Middle Name:
Last Name:OFARRILL
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 1:5445 CLEEK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-1833
Mailing Address - Country:US
Mailing Address - Phone:702-374-9273
Mailing Address - Fax:
Practice Address - Street 1:3520 E TROPICANA AVE STE 2C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7310
Practice Address - Country:US
Practice Address - Phone:702-374-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician