Provider Demographics
NPI:1780456343
Name:CONTRERA PORTAL, RAQUEL MARIA
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:MARIA
Last Name:CONTRERA PORTAL
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 1:4470 VEGAS VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-1909
Mailing Address - Country:US
Mailing Address - Phone:702-559-6547
Mailing Address - Fax:
Practice Address - Street 1:625 N LAMB BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-6355
Practice Address - Country:US
Practice Address - Phone:702-331-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant