Provider Demographics
NPI:1508411232
Name:JARAMILLO-LYOUBI, LUZ GIZELLE
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:GIZELLE
Last Name:JARAMILLO-LYOUBI
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 1:1351 W SUNSET RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-8608
Mailing Address - Country:US
Mailing Address - Phone:702-835-1102
Mailing Address - Fax:
Practice Address - Street 1:1351 W SUNSET RD STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8608
Practice Address - Country:US
Practice Address - Phone:702-835-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist