Healthcare Provider Details

I. General information

NPI: 1265910368
Provider Name (Legal Business Name): MIRIAM XOCHITH MANCILLA-RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 11/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 REYNOLDS AVE SUITE 100
N. LAS VEGAS NV
89030
US

IV. Provider business mailing address

2415 REYNOLDS AVE SUITE 100
N. LAS VEGAS NV
89030
US

V. Phone/Fax

Practice location:
  • Phone: 702-906-1999
  • Fax: 702-664-6933
Mailing address:
  • Phone: 702-906-1999
  • Fax: 702-664-6933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: