MEDICARE: MARILIZA CONSUL ILAGAN FNP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95001771	CA

General Provider Information

NPI Number	:	1114316320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILIZA CONSUL ILAGAN FNP

Provider Business Mailing Address
First Line	:	10001 SUMMER OAK LN UNIT 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-2624
Country	:	US
Telephone Number	:	562-215-9642
Fax Number	:	702-476-2975

Provider Business Practice Location Address
First Line	:	1321 S RAINBOW BLVD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9047
Country	:	US
Telephone Number	:	562-215-9642
Fax Number	:	702-476-2975

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

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	03/12/2020

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