Provider Demographics
NPI:1982576807
Name:GRAVIDEZ, JADE AGUILAR
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:AGUILAR
Last Name:GRAVIDEZ
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 1:4006 DEERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-4542
Mailing Address - Country:US
Mailing Address - Phone:702-752-0710
Mailing Address - Fax:
Practice Address - Street 1:4006 DEERFIELD AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4542
Practice Address - Country:US
Practice Address - Phone:702-752-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV876196251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health