Provider Demographics
NPI:1164920757
Name:DOMINGUEZ PADILLA, NELSON
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:DOMINGUEZ PADILLA
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 1:2651 SEARLES AVE APT 1046
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-9802
Mailing Address - Country:US
Mailing Address - Phone:702-980-8430
Mailing Address - Fax:
Practice Address - Street 1:2651 SEARLES AVE APT 1046
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-9802
Practice Address - Country:US
Practice Address - Phone:702-980-8430
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
NV1605284855OtherDRIVER LICENSE