Provider Demographics
NPI:1104792233
Name:VASQUEZ, DIVINA ASIS (RN)
Entity type:Individual
Prefix:
First Name:DIVINA
Middle Name:ASIS
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9225 HARBOR STREAM AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0132
Mailing Address - Country:US
Mailing Address - Phone:702-366-5451
Mailing Address - Fax:
Practice Address - Street 1:9225 HARBOR STREAM AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0132
Practice Address - Country:US
Practice Address - Phone:702-366-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV886036163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health