Provider Demographics
NPI:1609170380
Name:ALFARO TUMIALAN, VERONICA D
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:D
Last Name:ALFARO TUMIALAN
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 1:5016 ALTA DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-3927
Mailing Address - Country:US
Mailing Address - Phone:702-449-8229
Mailing Address - Fax:702-259-6311
Practice Address - Street 1:2500 RIALTO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-3925
Practice Address - Country:US
Practice Address - Phone:702-449-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVH14-00297-G-150517171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator