Provider Demographics
NPI:1902942725
Name:VERA, ADA IRIS (DPM)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:IRIS
Last Name:VERA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33250
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-3250
Mailing Address - Country:US
Mailing Address - Phone:702-878-5252
Mailing Address - Fax:702-878-1963
Practice Address - Street 1:3000 W CHARLESTON BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1940
Practice Address - Country:US
Practice Address - Phone:702-878-5252
Practice Address - Fax:702-878-1963
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0016213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1902942725Medicaid
NV1902942725Medicaid
NVV34280Medicare PIN