Provider Demographics
NPI:1174031876
Name:VILLASENOR-, VALERIA
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:
Last Name:VILLASENOR-
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 1:6024 PELE ST
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0680
Mailing Address - Country:US
Mailing Address - Phone:702-767-8487
Mailing Address - Fax:
Practice Address - Street 1:2001 S JONES BLVD STE K
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3165
Practice Address - Country:US
Practice Address - Phone:702-202-3492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant