Healthcare Provider Details

I. General information

NPI: 1477108116
Provider Name (Legal Business Name): SALLYANN ADA FICARROTTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 W FLAMINGO RD STE C5
LAS VEGAS NV
89103-0137
US

IV. Provider business mailing address

5550 W FLAMINGO RD STE C5
LAS VEGAS NV
89103-0137
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-2520
  • Fax:
Mailing address:
  • Phone: 702-877-2520
  • Fax:

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: