Provider Demographics
NPI:1316208978
Name:ESPERANZA, LUZMARIA
Entity Type:Individual
Prefix:
First Name:LUZMARIA
Middle Name:
Last Name:ESPERANZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUZMARIA
Other - Middle Name:
Other - Last Name:PORTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1801 BLUFF AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-3774
Mailing Address - Country:US
Mailing Address - Phone:702-513-4171
Mailing Address - Fax:
Practice Address - Street 1:1801 BLUFF AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3774
Practice Address - Country:US
Practice Address - Phone:702-513-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner