Provider Demographics
NPI:1043799216
Name:EZELI, CHINAZOR THELMA
Entity Type:Individual
Prefix:
First Name:CHINAZOR
Middle Name:THELMA
Last Name:EZELI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHINAZOR
Other - Middle Name:THELMA
Other - Last Name:EZELI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:149 TYLER CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-0660
Mailing Address - Country:US
Mailing Address - Phone:702-610-4190
Mailing Address - Fax:
Practice Address - Street 1:2800 W SAHARA AVE STE 6C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4383
Practice Address - Country:US
Practice Address - Phone:702-720-9037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist