MEDICARE: VANESSA KLEIN VICENCIO RRT

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	227900000X	Registered Respiratory Therapist	RC3257	NV

General Provider Information

NPI Number	:	1215703772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA KLEIN VICENCIO RRT

Provider Business Mailing Address
First Line	:	5693 S JONES BLVD STE 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1967
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5693 S JONES BLVD STE 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1967
Country	:	US
Telephone Number	:	702-791-5600
Fax Number	:

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

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	11/27/2023

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