Individual
AJA DEBRUYN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3900 E BONANZA RD, LAS VEGAS, NV 89110-2167
(702) 462-9778
Mailing address
3900 E BONANZA RD, LAS VEGAS, NV 89110-2167
(702) 462-9778
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
06A55C42F3
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0591T
—
CA
Enumeration date
09/15/2025
Last updated
09/15/2025
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