Provider Demographics
NPI:1659932911
Name:HERNANDEZ NAVARRO, BARBARA LAZARA
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LAZARA
Last Name:HERNANDEZ NAVARRO
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 1:3376 S EASTERN AVE STE 188A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3380
Mailing Address - Country:US
Mailing Address - Phone:702-980-5000
Mailing Address - Fax:702-463-2200
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:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3747P1801XMedicaid