Provider Demographics
NPI:1831775071
Name:ALONSO ODUARDO, OSCAR (APRN)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:ALONSO ODUARDO
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 SIMMONS ST
Mailing Address - Street 2:SUITE 1, BOX 563
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1840
Mailing Address - Country:US
Mailing Address - Phone:702-984-6888
Mailing Address - Fax:702-984-2147
Practice Address - Street 1:3186 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2306
Practice Address - Country:US
Practice Address - Phone:716-859-1499
Practice Address - Fax:702-984-2147
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV849977363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1215589353Medicaid