Provider Demographics
NPI:1548769078
Name:RIVERO CHARON, ADILEN
Entity Type:Individual
Prefix:
First Name:ADILEN
Middle Name:
Last Name:RIVERO CHARON
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 1:5100 E TROPICANA AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-6701
Mailing Address - Country:US
Mailing Address - Phone:702-762-4343
Mailing Address - Fax:
Practice Address - Street 1:5100 E TROPICANA AVE APT 2A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6701
Practice Address - Country:US
Practice Address - Phone:702-762-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV47-5440891376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker