Provider Demographics
NPI:1174387294
Name:CREUETS, ERNESTO RAFAEL
Entity type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:RAFAEL
Last Name:CREUETS
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 1:1650 E SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3494
Mailing Address - Country:US
Mailing Address - Phone:702-769-0584
Mailing Address - Fax:
Practice Address - Street 1:7429 FENCEROW ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4546
Practice Address - Country:US
Practice Address - Phone:702-465-5068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant