Provider Demographics
NPI:1114425782
Name:ALVAREZ CORREA, MANUEL ENRIQUE
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ENRIQUE
Last Name:ALVAREZ CORREA
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 1:3823 S MARYLAND PKWY UNIT N7
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7543
Mailing Address - Country:US
Mailing Address - Phone:702-502-6136
Mailing Address - Fax:
Practice Address - Street 1:3823 S MARYLAND PKWY UNIT N7
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7543
Practice Address - Country:US
Practice Address - Phone:702-502-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2104155102OtherDRIVER LICENSE