Provider Information for 1679873780
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DESIREE C CANTORNA-IBARRA LCPC, CADC-I
Other Names:Former Name:DESIREE C CANTORNA LCPC, CADC-ISex: Female
NPI: 1679873780
Last Updated: 2016-01-21
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1679873780 | ||||||||||||
| Enumeration Date | 2010-10-25 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 5812 SUTCLIFFE CIR LAS VEGAS, NV 89110-3855 United States Phone: 702-769-9211 | Fax: | ||||||||||||
| Primary Practice Address | 5812 SUTCLIFFE CIR LAS VEGAS, NV 89110-3855 United States Phone: 702-769-9211 | Fax: | ||||||||||||
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