Provider Demographics
NPI:1205458445
Name:PINA FREIJO, WUILBER
Entity type:Individual
Prefix:
First Name:WUILBER
Middle Name:
Last Name:PINA FREIJO
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 1:615 S ROYAL CREST CIR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3817
Mailing Address - Country:US
Mailing Address - Phone:725-221-0339
Mailing Address - Fax:
Practice Address - Street 1:615 S ROYAL CREST CIR UNIT 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3817
Practice Address - Country:US
Practice Address - Phone:725-221-0339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant