Provider Demographics
NPI:1598124067
Name:AHOUSE, IVONNE GUADALUPE (BLAS)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:GUADALUPE
Last Name:AHOUSE
Suffix:
Gender:F
Credentials:BLAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255A RENAISSANCE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6194
Mailing Address - Country:US
Mailing Address - Phone:702-451-7542
Mailing Address - Fax:702-450-4239
Practice Address - Street 1:2255A RENAISSANCE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6194
Practice Address - Country:US
Practice Address - Phone:702-451-7542
Practice Address - Fax:702-450-4239
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner