Provider Demographics
NPI:1083194682
Name:SALCEDO LICEA, ADAIRIS
Entity Type:Individual
Prefix:
First Name:ADAIRIS
Middle Name:
Last Name:SALCEDO LICEA
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 1:2701 N RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4558
Mailing Address - Country:US
Mailing Address - Phone:702-466-6137
Mailing Address - Fax:
Practice Address - Street 1:2701 N RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4558
Practice Address - Country:US
Practice Address - Phone:702-466-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1404497331OtherID