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NPI Code Detail

MEDICARE: NEURO REVOLT PSYCHIATRY PLLC

MEDICARE: NEURO REVOLT PSYCHIATRY PLLC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1588507966
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEURO REVOLT PSYCHIATRY PLLC
Provider Business Mailing Address
First Line : 6592 N DECATUR BLVD STE 150
Second Line : PMB #129
City : LAS VEGAS
State : NV
Zip : 89131-1040
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8778 S MARYLAND PKWY STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-6705
Country : US
Telephone Number : 725-292-2130
Fax Number :
Authorized Official
Title or Position : PSYCHIATRIC NURSE PRACTITIONER
Name : MARIAH ANGUITA
Credential : APRN, PMHNP-BC
Telephone Number : 725-292-2130
Provider Enumeration Date : 04/11/2026
Last Update Date : 04/11/2026

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Directions to “NEURO REVOLT PSYCHIATRY PLLC ” Practice Location

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