Provider Demographics
NPI:1619536265
Name:PLATERO DE AYALA, MARIA ELENA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:PLATERO DE AYALA
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 1:5534 SUPER BOWL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5634
Mailing Address - Country:US
Mailing Address - Phone:213-361-3651
Mailing Address - Fax:
Practice Address - Street 1:3376 S EASTERN AVE STE 188A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3380
Practice Address - Country:US
Practice Address - Phone:702-980-5000
Practice Address - Fax:702-463-2200
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3747P1801XMedicaid