Provider Demographics
NPI:1225760762
Name:CENICEROS HERRADA, LUZ MARIA
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:MARIA
Last Name:CENICEROS HERRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:MARIA
Other - Last Name:CENICEROS HERRADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2415 REYNOLDS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2415 REYNOLDS AVE STE 101
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030
Practice Address - Country:US
Practice Address - Phone:702-722-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant