Individual
GLEN MAR ALFONSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EMT, LPN
Contact information
Practice address
250 PILOT RD STE 250, LAS VEGAS, NV 89119-3514
(702) 982-3292
Mailing address
3624 BELLA LEGATO AVE, N LAS VEGAS, NV 89081-4044
(725) 465-0475
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
886439
NV
Other
Enumeration date
03/29/2025
Last updated
03/29/2025
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