Provider Demographics
NPI:1083243869
Name:BAILETTI, EDUARDO MARTIN
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:MARTIN
Last Name:BAILETTI
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 1:2664 N BUFFALO DR UNIT 2118
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4814
Mailing Address - Country:US
Mailing Address - Phone:520-205-1851
Mailing Address - Fax:
Practice Address - Street 1:2664 N BUFFALO DR UNIT 2118
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4814
Practice Address - Country:US
Practice Address - Phone:520-205-1851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant