Provider Demographics
NPI:1619432879
Name:ESTRADA MEJIA, LESBIA MAGALY
Entity Type:Individual
Prefix:
First Name:LESBIA
Middle Name:MAGALY
Last Name:ESTRADA MEJIA
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 1:509 N DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1942
Mailing Address - Country:US
Mailing Address - Phone:702-524-0734
Mailing Address - Fax:
Practice Address - Street 1:509 N DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1942
Practice Address - Country:US
Practice Address - Phone:702-524-0734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant