Provider Demographics
NPI:1154057396
Name:PADILLA-SALAS, ANNA ROSA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ROSA
Last Name:PADILLA-SALAS
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 1:2509 WESTFALL RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-6126
Mailing Address - Country:US
Mailing Address - Phone:775-954-8835
Mailing Address - Fax:
Practice Address - Street 1:2509 WESTFALL RD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-6126
Practice Address - Country:US
Practice Address - Phone:775-954-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPCS-77433747A0650X, 376J00000X, 3747P1801X, 372600000X, 372500000X, 374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV45-4954858Medicaid