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General NPI Number Information
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NPI Number | 1073327375
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Entity Type | Organization
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Legal Business Name | ADULT-GERONTOLOGY MEDICAL, LLC
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Dates
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Enumeration Date | 02/05/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 2670 CHANDLER AVE STE 3
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City | LAS VEGAS
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State | NV
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Zip | 89120-4084
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Country | US
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Telephone | 702-695-2270
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Fax |
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Provider Business Mailing Address
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Address Line | 9936 BUNDELLA DR
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City | LAS VEGAS
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State | NV
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Zip | 89134-7574
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIA SABANICO
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Credential | NP, APRN, RN
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Telephone | 702-659-2270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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