Provider Demographics
NPI:1558018812
Name:DOMINGUEZ, EVELYN REYES
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:REYES
Last Name:DOMINGUEZ
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 1:3525 VILLA KNOLLS SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-1241
Mailing Address - Country:US
Mailing Address - Phone:702-741-6345
Mailing Address - Fax:
Practice Address - Street 1:1775 E TROPICANA AVE STE 16B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6557
Practice Address - Country:US
Practice Address - Phone:702-405-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant