Provider Demographics
NPI:1801396056
Name:OROZCO LARA, JAZMIN ALEJANDRA
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:ALEJANDRA
Last Name:OROZCO LARA
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 1:1316 E HACIENDA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-1949
Mailing Address - Country:US
Mailing Address - Phone:702-890-6500
Mailing Address - Fax:
Practice Address - Street 1:2330 PASEO DEL PRADO STE C307
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0076
Practice Address - Country:US
Practice Address - Phone:725-600-7953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant