Provider Demographics
NPI:1588254122
Name:VICERAL, MA CRISTINA MENESES (APRN-FNP-C)
Entity type:Individual
Prefix:
First Name:MA CRISTINA
Middle Name:MENESES
Last Name:VICERAL
Suffix:
Gender:
Credentials:APRN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 E TOMPKINS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7394
Mailing Address - Country:US
Mailing Address - Phone:725-724-2005
Mailing Address - Fax:877-418-8013
Practice Address - Street 1:2480 E TOMPKINS AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5466
Practice Address - Country:US
Practice Address - Phone:725-724-2005
Practice Address - Fax:877-418-8013
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV836771363L00000X, 363LA2200X, 363LF0000X
NVPMH12240031363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health