Healthcare Provider Details

I. General information

NPI: 1225509219
Provider Name (Legal Business Name): RAQUEL LLAMAS MARISCAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7390 W SAHARA AVE STE 260
LAS VEGAS NV
89117-2765
US

IV. Provider business mailing address

7390 W SAHARA AVE STE 260
LAS VEGAS NV
89117-2765
US

V. Phone/Fax

Practice location:
  • Phone: 702-900-4320
  • Fax: 608-646-6142
Mailing address:
  • Phone: 702-900-4320
  • Fax: 608-646-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: