Provider Demographics
NPI:1699525360
Name:BURCIAGA-HERNANDEZ, CONSUELO AIDE
Entity type:Individual
Prefix:
First Name:CONSUELO
Middle Name:AIDE
Last Name:BURCIAGA-HERNANDEZ
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 1:8540 S EASTERN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2855
Mailing Address - Country:US
Mailing Address - Phone:702-268-7827
Mailing Address - Fax:
Practice Address - Street 1:8540 S EASTERN AVE STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2855
Practice Address - Country:US
Practice Address - Phone:702-268-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant