Healthcare Provider Details

I. General information

NPI: 1700397767
Provider Name (Legal Business Name): RACHEL MEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 W AZURE DR
LAS VEGAS NV
89130-4418
US

IV. Provider business mailing address

11393 RANCHO VILLA VERDE PL
LAS VEGAS NV
89138-1551
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-4009
  • Fax:
Mailing address:
  • Phone: 702-343-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-0966
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: