Healthcare Provider Details

I. General information

NPI: 1194483867
Provider Name (Legal Business Name): MARIA SABANICO APRN P PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9936 BUNDELLA DR
LAS VEGAS NV
89134-7574
US

IV. Provider business mailing address

9936 BUNDELLA DR
LAS VEGAS NV
89134-7574
US

V. Phone/Fax

Practice location:
  • Phone: 702-659-2270
  • Fax: 702-522-6071
Mailing address:
  • Phone: 702-659-2270
  • Fax: 702-522-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA SABANICO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 702-659-2270