Healthcare Provider Details

I. General information

NPI: 1508009085
Provider Name (Legal Business Name): MARILYN G. MASCHGAN LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N PECOS RD SUITE G
HENDERSON NV
89074-1349
US

IV. Provider business mailing address

301 N PECOS RD SUITE G
HENDERSON NV
89074-1349
US

V. Phone/Fax

Practice location:
  • Phone: 702-732-3800
  • Fax: 702-732-4747
Mailing address:
  • Phone: 702-732-3800
  • Fax: 702-732-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-17
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number#8
License Number StateNV

VIII. Authorized Official

Name: ASHLEY ROMERO
Title or Position: OWNER/OFFICER
Credential:
Phone: 702-732-3800