MEDICARE: PATRICIA PATINO-CERVANTES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1013491679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA PATINO-CERVANTES

Provider Business Mailing Address
First Line	:	3920 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1631
Country	:	US
Telephone Number	:	702-478-5541
Fax Number	:

Provider Business Practice Location Address
First Line	:	3920 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1631
Country	:	US
Telephone Number	:	702-478-5541
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2018
Last Update Date	:	09/19/2018

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Directions to “ PATRICIA PATINO-CERVANTES ” Practice Location

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