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General NPI Number Information
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NPI Number | 1194296434
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Entity Type | Individual
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Provider Name | MARY GRACE SUDARIO GRECIA
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Gender | Female
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 12/16/2018
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Provider Practice Location Address
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Address Line | 2680 S JONES BLVD STE 2
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City | LAS VEGAS
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State | NV
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Zip | 89146-5634
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Country | US
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Telephone | 702-227-0005
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Fax | 702-220-7915
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Provider Business Mailing Address
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Address Line | 2680 S JONES BLVD STE 2
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City | LAS VEGAS
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State | NV
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Zip | 89146-5634
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Country | US
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Telephone | 702-227-0005
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Fax | 702-220-7915
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 3829HHA-13
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License Number State | NV
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