Provider Demographics
NPI:1962097964
Name:DELA PENA, DHARLY GRACE CAMBONGGA
Entity type:Individual
Prefix:
First Name:DHARLY GRACE
Middle Name:CAMBONGGA
Last Name:DELA PENA
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 1:5122 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2126
Mailing Address - Country:US
Mailing Address - Phone:702-480-2133
Mailing Address - Fax:
Practice Address - Street 1:5122 SPENCER ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2126
Practice Address - Country:US
Practice Address - Phone:702-480-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant