MEDICARE: MAYRA ORNELAS

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	225400000X	Rehabilitation Practitioner	0001688711	NV

General Provider Information

NPI Number	:	1770904104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRA ORNELAS

Provider Business Mailing Address
First Line	:	3145 MANTI PEAK AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-6550
Country	:	US
Telephone Number	:	702-750-8279
Fax Number	:	702-632-0806

Provider Business Practice Location Address
First Line	:	3145 MANTI PEAK AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-6550
Country	:	US
Telephone Number	:	702-750-8279
Fax Number	:	702-632-0806

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

Provider Enumeration Date	:	01/03/2014
Last Update Date	:	01/03/2014

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Directions to “ MAYRA ORNELAS ” Practice Location

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