Provider Demographics
NPI:1477857431
Name:BALDERAS-NUNEZ, ANA KAREN
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:KAREN
Last Name:BALDERAS-NUNEZ
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 1:2205 SIESTA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3223
Mailing Address - Country:US
Mailing Address - Phone:702-445-9775
Mailing Address - Fax:
Practice Address - Street 1:2205 SIESTA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3223
Practice Address - Country:US
Practice Address - Phone:702-445-9775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner