Provider Demographics
NPI:1538987102
Name:VILLALON HERNANDEZ, SHIRLYS
Entity type:Individual
Prefix:
First Name:SHIRLYS
Middle Name:
Last Name:VILLALON HERNANDEZ
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 1:5075 SPYGLASS HILL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-2776
Mailing Address - Country:US
Mailing Address - Phone:702-957-8616
Mailing Address - Fax:
Practice Address - Street 1:2121 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5122
Practice Address - Country:US
Practice Address - Phone:702-981-1484
Practice Address - Fax:702-995-0242
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant