Provider Demographics
NPI:1275901225
Name:ENAMORADO LABRADA, ANTONIO SR
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:ENAMORADO LABRADA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 S BRUCE ST
Mailing Address - Street 2:17
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6083
Mailing Address - Country:US
Mailing Address - Phone:702-209-6895
Mailing Address - Fax:
Practice Address - Street 1:2780 S JONES BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5628
Practice Address - Country:US
Practice Address - Phone:702-778-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health