Provider Demographics
NPI:1720545916
Name:BUENDIA, NELIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:NELIA
Middle Name:
Last Name:BUENDIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 VISTA LARGA CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-1815
Mailing Address - Country:US
Mailing Address - Phone:775-787-1188
Mailing Address - Fax:775-787-1188
Practice Address - Street 1:5325 VISTA LARGA CIR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-1815
Practice Address - Country:US
Practice Address - Phone:775-787-1188
Practice Address - Fax:775-787-1188
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVR115348A311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005056674Medicaid