Provider Demographics
NPI:1962793372
Name:PEREZ, EDNA L
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:L
Last Name:PEREZ
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 1:2965 S JONES BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5629
Mailing Address - Country:US
Mailing Address - Phone:702-733-8098
Mailing Address - Fax:702-395-6457
Practice Address - Street 1:2965 S JONES BLVD
Practice Address - Street 2:STE D
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5629
Practice Address - Country:US
Practice Address - Phone:702-733-8098
Practice Address - Fax:702-395-6457
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747A0650X, 376J00000X, 3747P1801X, 372500000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion