Provider Demographics
NPI:1770590606
Name:PALAFOX, DESEREE D (APN-C)
Entity type:Individual
Prefix:
First Name:DESEREE
Middle Name:D
Last Name:PALAFOX
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:DESEREE
Other - Middle Name:P
Other - Last Name:DEL ROSARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1800 W. CHARLESTON BLVD. STE. 508
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2688
Mailing Address - Fax:702-671-6595
Practice Address - Street 1:1700 WHEELER PEAK DR.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-383-2565
Practice Address - Fax:702-646-0298
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV102136Medicare ID - Type Unspecified
NVQ65487Medicare UPIN