Provider Demographics
NPI:1174275259
Name:AISA, MARIA CRISELDA D
Entity type:Individual
Prefix:
First Name:MARIA CRISELDA
Middle Name:D
Last Name:AISA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARI CRISELDA
Other - Middle Name:A
Other - Last Name:DE LA CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8879 W FLAMINGO RD # ATE101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8755
Mailing Address - Country:US
Mailing Address - Phone:702-701-9951
Mailing Address - Fax:
Practice Address - Street 1:2625 WHITE OAK RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-5340
Practice Address - Country:US
Practice Address - Phone:702-376-0623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant