Provider Demographics
NPI:1467940635
Name:FRONTERA, CARLOS JUAN SR (PCA)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:JUAN
Last Name:FRONTERA
Suffix:SR
Gender:M
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8670 W CHEYENNE AVE STE 135
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7460
Mailing Address - Country:US
Mailing Address - Phone:702-822-2600
Mailing Address - Fax:
Practice Address - Street 1:2700 S VALLEY VIEW BLVD APT C1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-5918
Practice Address - Country:US
Practice Address - Phone:702-953-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant