Provider Demographics
NPI:1912777012
Name:VERA CRUZ, ESTHER ROSALIE SUELO
Entity Type:Individual
Prefix:
First Name:ESTHER ROSALIE
Middle Name:SUELO
Last Name:VERA CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:SUELO
Other - Last Name:VERA CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:8688 BELLA SPARKLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-7567
Mailing Address - Country:US
Mailing Address - Phone:661-888-3227
Mailing Address - Fax:
Practice Address - Street 1:8688 BELLA SPARKLE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-7567
Practice Address - Country:US
Practice Address - Phone:661-888-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV87326101YA0400X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)