Provider Demographics
NPI:1043740442
Name:MINABOWAN, PAPAREX EDIRIN
Entity Type:Individual
Prefix:MR
First Name:PAPAREX
Middle Name:EDIRIN
Last Name:MINABOWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 S EASTERN AVE APT 1325
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2964
Mailing Address - Country:US
Mailing Address - Phone:907-764-1035
Mailing Address - Fax:
Practice Address - Street 1:1810 E SAHARA AVE # 108
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3707
Practice Address - Country:US
Practice Address - Phone:702-822-0447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251E00000X, 253Z00000X
NVNV20171341089172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care