Provider Demographics
NPI:1962095075
Name:HECHEMENDIA, ENMA ROSA
Entity type:Individual
Prefix:MS
First Name:ENMA
Middle Name:ROSA
Last Name:HECHEMENDIA
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 1:5756 SLICE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-2024
Mailing Address - Country:US
Mailing Address - Phone:702-969-3982
Mailing Address - Fax:
Practice Address - Street 1:3486 E SAHARA AVE SUITE 160-C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104
Practice Address - Country:US
Practice Address - Phone:702-431-2232
Practice Address - Fax:702-431-2598
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician