Provider Demographics
NPI:1891277406
Name:DELCID, ELSA
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:DELCID
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 1:6128 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3051
Mailing Address - Country:US
Mailing Address - Phone:702-598-2048
Mailing Address - Fax:702-598-2041
Practice Address - Street 1:14192 N CALICO DR
Practice Address - Street 2:
Practice Address - City:DOLAN SPRINGS
Practice Address - State:AZ
Practice Address - Zip Code:86441-9543
Practice Address - Country:US
Practice Address - Phone:702-428-1272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid