Provider Demographics
NPI:1104394436
Name:DENISIS VARONA-CHALA
Entity Type:Organization
Organization Name:DENISIS VARONA-CHALA
Other - Org Name:SIMPLE TAX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VARONA CHALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-296-2765
Mailing Address - Street 1:4714 E FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4709
Mailing Address - Country:US
Mailing Address - Phone:702-685-7770
Mailing Address - Fax:
Practice Address - Street 1:4714 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4709
Practice Address - Country:US
Practice Address - Phone:702-685-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2003733.054-122OtherBUSINESS LICENSE NUMBER