Provider Demographics
NPI:1407332513
Name:PUENTE NOA, LUCELIA
Entity Type:Individual
Prefix:
First Name:LUCELIA
Middle Name:
Last Name:PUENTE NOA
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 1:3529 BOOTH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-3424
Mailing Address - Country:US
Mailing Address - Phone:702-444-9756
Mailing Address - Fax:
Practice Address - Street 1:3529 BOOTH ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3424
Practice Address - Country:US
Practice Address - Phone:702-444-9756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1405705728OtherDL