Healthcare Provider Details

I. General information

NPI: 1821642810
Provider Name (Legal Business Name): MARIA LUNA SABANICO ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2019
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 Number823099
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number823099
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number823099
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number823099
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number823099
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number823099
License Number StateNV
# 7
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number823099
License Number StateNV
# 8
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number823099
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: