MEDICARE: MARIA LUISA CAGUICLA

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	171W00000X	Contractor	2000454803	NV

General Provider Information

NPI Number	:	1881996023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA LUISA CAGUICLA

Provider Business Mailing Address
First Line	:	6121 PEACH ORCHARD RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-0949
Country	:	US
Telephone Number	:	702-431-7444
Fax Number	:

Provider Business Practice Location Address
First Line	:	6121 PEACH ORCHARD RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-0949
Country	:	US
Telephone Number	:	702-431-7444
Fax Number	:

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

Provider Enumeration Date	:	11/20/2010
Last Update Date	:	11/20/2010

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Directions to “ MARIA LUISA CAGUICLA ” Practice Location

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