Provider Demographics
NPI:1376313379
Name:PENAFLOR, EDELYN AVELINO (BSN, RN)
Entity Type:Individual
Prefix:
First Name:EDELYN
Middle Name:AVELINO
Last Name:PENAFLOR
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7979 DIAMOND SKY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-6269
Mailing Address - Country:US
Mailing Address - Phone:562-235-9565
Mailing Address - Fax:
Practice Address - Street 1:4040 S EASTERN AVE STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0854
Practice Address - Country:US
Practice Address - Phone:702-463-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV838369163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice