Provider Demographics
NPI:1801369145
Name:BALTAZAR, IVONNE YOLANDA
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:YOLANDA
Last Name:BALTAZAR
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 1:312 ORLAND ST APT 61
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1658
Mailing Address - Country:US
Mailing Address - Phone:702-689-2772
Mailing Address - Fax:
Practice Address - Street 1:2901 SCHAFFER CIR APT 19B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2230
Practice Address - Country:US
Practice Address - Phone:702-510-6157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant