Provider Demographics
NPI:1891294120
Name:HERRERA RODRIGUEZ, LEITTER
Entity Type:Individual
Prefix:
First Name:LEITTER
Middle Name:
Last Name:HERRERA RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 WEMBLY HILLS PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-2564
Mailing Address - Country:US
Mailing Address - Phone:702-576-3118
Mailing Address - Fax:
Practice Address - Street 1:952 WEMBLY HILLS PL
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-2564
Practice Address - Country:US
Practice Address - Phone:702-576-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant