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General NPI Number Information
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NPI Number | 1861053076
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Entity Type | Individual
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Provider Name | MANUEL CARRANZA
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Gender | Male
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 2950 E FLAMINGO RD STE E
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City | LAS VEGAS
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State | NV
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Zip | 89121-5208
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Country | US
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Telephone | 702-423-0011
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Fax | 725-204-2859
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Provider Business Mailing Address
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Address Line | 460 LACABANA BEACH DR
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City | LAS VEGAS
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State | NV
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Zip | 89138-7542
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Country | US
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Telephone | 702-544-1261
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Fax | 725-204-2859
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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 | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number | 00095049
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License Number State | NV
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