Provider Demographics
NPI:1265856736
Name:LIZASO, ROMINA
Entity type:Individual
Prefix:
First Name:ROMINA
Middle Name:
Last Name:LIZASO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NURTURED ROOTS
Other - Middle Name:
Other - Last Name:MIDWIFERY CARE, LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8425 GILLETTE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8425 GILLETTE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-9084
Practice Address - Country:US
Practice Address - Phone:702-750-6791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
NV176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula