MEDICARE: ADULT-GERONTOLOGY MEDICAL, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QC1500X	Community Health Clinic/Center
2	261QP3300X	Pain Clinic/Center
3	363LA2100X	Acute Care Nurse Practitioner
4	363LA2200X	Adult Health Nurse Practitioner
5	363LG0600X	Gerontology Nurse Practitioner
6	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1073327375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT-GERONTOLOGY MEDICAL, LLC

Provider Business Mailing Address
First Line	:	9936 BUNDELLA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-7574
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2670 CHANDLER AVE STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4084
Country	:	US
Telephone Number	:	702-695-2270
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA SABANICO
Credential	:	NP, APRN, RN
Telephone Number	:	702-659-2270

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	02/12/2025

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