MEDICARE: MARIA PERPETUA DE LA PAZ RPH

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	14873	NV

General Provider Information

NPI Number	:	1033740790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA PERPETUA DE LA PAZ RPH

Provider Business Mailing Address
First Line	:	3602 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-2161
Country	:	US
Telephone Number	:	702-438-1091
Fax Number	:	702-438-0742

Provider Business Practice Location Address
First Line	:	3602 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-2161
Country	:	US
Telephone Number	:	702-438-1091
Fax Number	:	702-438-0742

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

Provider Enumeration Date	:	01/31/2020
Last Update Date	:	01/31/2020

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