=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568218204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH MAE AGBILAY MEZA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2024
-----------------------------------------------------
Last Update Date | 11/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3145 E WARM SPRINGS RD STE 400
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120-3140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-919-9515
-----------------------------------------------------
Fax | 702-944-5498
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3145 E WARM SPRINGS RD STE 400
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120-3140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-919-9515
-----------------------------------------------------
Fax | 702-944-5498
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------