Provider Demographics
NPI:1215588637
Name:VIZCARRA, ROSARIO MANUEL
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:MANUEL
Last Name:VIZCARRA
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 1:2961 E SERENE AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6507
Mailing Address - Country:US
Mailing Address - Phone:702-948-4848
Mailing Address - Fax:702-948-4845
Practice Address - Street 1:2961 E SERENE AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6507
Practice Address - Country:US
Practice Address - Phone:702-948-4848
Practice Address - Fax:702-948-4845
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant