Provider Demographics
NPI:1508635681
Name:BALTAZAR, HORACIO ADRIAN
Entity Type:Individual
Prefix:
First Name:HORACIO
Middle Name:ADRIAN
Last Name:BALTAZAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 S EASTERN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6139
Mailing Address - Country:US
Mailing Address - Phone:702-462-5251
Mailing Address - Fax:702-553-3482
Practice Address - Street 1:4660 S EASTERN AVE STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6139
Practice Address - Country:US
Practice Address - Phone:702-462-5251
Practice Address - Fax:702-553-3482
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant