MEDICARE: JENNIE INGUANZO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	225400000X	Rehabilitation Practitioner
3	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1023303104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIE INGUANZO

Provider Business Mailing Address
First Line	:	8225 W SAHARA AVE STE H
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-8929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8225 W SAHARA AVE STE H
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-8929
Country	:	US
Telephone Number	:	702-476-2899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	02/12/2026

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