Provider Demographics
NPI:1790574259
Name:IBARRIENTOS, CHERUBIM COSTA (RN)
Entity type:Individual
Prefix:
First Name:CHERUBIM
Middle Name:COSTA
Last Name:IBARRIENTOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHERUBIM
Other - Middle Name:RAAGAS
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4104 REDFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-2697
Mailing Address - Country:US
Mailing Address - Phone:575-390-8924
Mailing Address - Fax:
Practice Address - Street 1:250 PILOT RD STE 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3514
Practice Address - Country:US
Practice Address - Phone:725-334-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV842043163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse