Provider Demographics
NPI:1508477308
Name:DURAN-BROCATO, AMNERIS LIZET
Entity Type:Individual
Prefix:
First Name:AMNERIS
Middle Name:LIZET
Last Name:DURAN-BROCATO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMNERIS
Other - Middle Name:LIZET
Other - Last Name:DURAN-BROCATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1150 NORTH BUFFALO DR. APT 2120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-788-4177
Mailing Address - Fax:
Practice Address - Street 1:1150 NORTH BUFFALO DR. APT 2120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-788-4177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant