Healthcare Provider Details

I. General information

NPI: 1033683404
Provider Name (Legal Business Name): MARISSA CHESEBRO CST/CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9260 W SUNSET RD STE 309
LAS VEGAS NV
89148-4858
US

IV. Provider business mailing address

9260 W SUNSET RD
LAS VEGAS NV
89148-4858
US

V. Phone/Fax

Practice location:
  • Phone: 702-963-1231
  • Fax: 702-442-9309
Mailing address:
  • Phone: 702-321-1368
  • Fax: 702-442-9309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number180733
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: