Provider Demographics
NPI:1730834789
Name:ABRENICA, ELIJAH BY
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:BY
Last Name:ABRENICA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7715 FRENCHMANS BAY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89179-1451
Mailing Address - Country:US
Mailing Address - Phone:702-482-6009
Mailing Address - Fax:
Practice Address - Street 1:7715 FRENCHMANS BAY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89179-1451
Practice Address - Country:US
Practice Address - Phone:702-482-6009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant