Provider Demographics
NPI:1639711062
Name:WEITZ, TYRENE REBECCA
Entity Type:Individual
Prefix:
First Name:TYRENE
Middle Name:REBECCA
Last Name:WEITZ
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 1:6820 W SAHARA AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-2816
Mailing Address - Country:US
Mailing Address - Phone:702-846-7005
Mailing Address - Fax:
Practice Address - Street 1:6820 W SAHARA AVE STE 5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2816
Practice Address - Country:US
Practice Address - Phone:702-846-7005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider