Provider Demographics
NPI:1659978153
Name:CHONGSON, LIDUVINA
Entity Type:Individual
Prefix:
First Name:LIDUVINA
Middle Name:
Last Name:CHONGSON
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 1:3812 MELLON CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-2877
Mailing Address - Country:US
Mailing Address - Phone:702-218-3784
Mailing Address - Fax:
Practice Address - Street 1:1064 E SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3220
Practice Address - Country:US
Practice Address - Phone:702-998-4865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide