Healthcare Provider Details

I. General information

NPI: 1255269767
Provider Name (Legal Business Name): AMANDA PAEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 N RAINBOW BLVD STE 100
LAS VEGAS NV
89108-7098
US

IV. Provider business mailing address

4045 SPENCER ST STE A59
LAS VEGAS NV
89119-9311
US

V. Phone/Fax

Practice location:
  • Phone: 702-452-2020
  • Fax:
Mailing address:
  • Phone: 702-452-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: