Provider Demographics
NPI:1649666108
Name:HINES, MATIA LOLA-LAMARA
Entity type:Individual
Prefix:
First Name:MATIA
Middle Name:LOLA-LAMARA
Last Name:HINES
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 1:6124 FANTASTIC TACHI ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6683
Mailing Address - Country:US
Mailing Address - Phone:702-510-3229
Mailing Address - Fax:
Practice Address - Street 1:6124 FANTASTIC TACHI ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6683
Practice Address - Country:US
Practice Address - Phone:702-510-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-11
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide