Healthcare Provider Details

I. General information

NPI: 1366934481
Provider Name (Legal Business Name): RICH-MAZZEO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 N MCCARRAN BLVD STE 104
SPARKS NV
89431-3873
US

IV. Provider business mailing address

1321 N MCCARRAN BLVD STE 104
SPARKS NV
89431-3873
US

V. Phone/Fax

Practice location:
  • Phone: 775-870-3093
  • Fax: 775-800-1651
Mailing address:
  • Phone: 775-683-3833
  • Fax: 775-683-3831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number002280
License Number StateNV

VIII. Authorized Official

Name: BRENDA MANJARRES
Title or Position: PRACTICE MANAGER
Credential:
Phone: 775-683-3833