Healthcare Provider Details

I. General information

NPI: 1497913917
Provider Name (Legal Business Name): RAQUEL REZENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 W PIONEER BLVD STE 103
MESQUITE NV
89027-8890
US

IV. Provider business mailing address

4894 W LONE MOUNTAIN RD # 148
LAS VEGAS NV
89130-2239
US

V. Phone/Fax

Practice location:
  • Phone: 702-465-1462
  • Fax: 702-714-7410
Mailing address:
  • Phone: 702-465-1462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number98714
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP5613
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: