MEDICARE: CRISTIANO SEBASTIAN MITCHELL

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	1041C0700X	Clinical Social Worker	12799C	NV

General Provider Information

NPI Number	:	1366220360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTIANO SEBASTIAN MITCHELL

Provider Business Mailing Address
First Line	:	457 VIA STRETTO AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011-0837
Country	:	US
Telephone Number	:	702-817-1663
Fax Number	:

Provider Business Practice Location Address
First Line	:	2980 S RAINBOW BLVD # 200B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6531
Country	:	US
Telephone Number	:	702-817-1663
Fax Number	:

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

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	05/20/2026

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