Provider Demographics
NPI:1467171645
Name:AVILA BALSA, ALEJANDRA (CHW 1)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:AVILA BALSA
Suffix:
Gender:F
Credentials:CHW 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 E DESERT INN RD STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3694
Mailing Address - Country:US
Mailing Address - Phone:702-602-5106
Mailing Address - Fax:
Practice Address - Street 1:2755 E DESERT INN RD STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3694
Practice Address - Country:US
Practice Address - Phone:702-602-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-5174172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker