Provider Demographics
NPI:1497256754
Name:VELASCO, IRMA M (PCA)
Entity Type:Individual
Prefix:MS
First Name:IRMA
Middle Name:M
Last Name:VELASCO
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8058 PONDEROSA HILL ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4419
Mailing Address - Country:US
Mailing Address - Phone:702-334-9816
Mailing Address - Fax:
Practice Address - Street 1:8058 PONDEROSA HILL ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4419
Practice Address - Country:US
Practice Address - Phone:702-334-9816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV$$$$$$$$$OtherSOCIAL SECURITY