Provider Demographics
NPI:1699277657
Name:PEREZ LARA, ILEANA CORINA
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:CORINA
Last Name:PEREZ LARA
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 1:9896 FEBRUARY FALLS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-3534
Mailing Address - Country:US
Mailing Address - Phone:702-272-9970
Mailing Address - Fax:
Practice Address - Street 1:5000 W OAKEY BLVD STE E1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3398
Practice Address - Country:US
Practice Address - Phone:702-733-2890
Practice Address - Fax:702-733-4951
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4100719908OtherDRIVER LICENSE