Healthcare Provider Details

I. General information

NPI: 1407236789
Provider Name (Legal Business Name): MRS. RUBY MARIA SYDNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4538 W CRAIG RD STE 290
NORTH LAS VEGAS NV
89032-2511
US

IV. Provider business mailing address

4538 W CRAIG RD STE 290
NORTH LAS VEGAS NV
89032-2511
US

V. Phone/Fax

Practice location:
  • Phone: 702-250-6086
  • Fax:
Mailing address:
  • Phone: 702-250-6086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: