Provider Demographics
NPI:1255845699
Name:MELLA PEREZ, DAIMARIS
Entity Type:Individual
Prefix:
First Name:DAIMARIS
Middle Name:
Last Name:MELLA PEREZ
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 1:3001 GAREHIME ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4341
Mailing Address - Country:US
Mailing Address - Phone:702-945-7735
Mailing Address - Fax:
Practice Address - Street 1:8225 W SAHARA AVE STE H
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8929
Practice Address - Country:US
Practice Address - Phone:702-476-2899
Practice Address - Fax:702-476-1575
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 225400000X
NVCHW1-5267172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner