Healthcare Provider Details

I. General information

NPI: 1568218204
Provider Name (Legal Business Name): SARAH MAE AGBILAY MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAE MEZA

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 E WARM SPRINGS RD STE 400
LAS VEGAS NV
89120-3140
US

IV. Provider business mailing address

3145 E WARM SPRINGS RD STE 400
LAS VEGAS NV
89120-3140
US

V. Phone/Fax

Practice location:
  • Phone: 702-919-9515
  • Fax: 702-944-5498
Mailing address:
  • Phone: 702-919-9515
  • Fax: 702-944-5498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: