MEDICARE: REYNALDA MAGDALENA GARCIA MENESES

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	207Q00000X	Family Medicine Physician	815949	NV
2	363L00000X	Nurse Practitioner	815949	NV

General Provider Information

NPI Number	:	1104399617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYNALDA MAGDALENA GARCIA MENESES

Provider Business Mailing Address
First Line	:	4712 SAN MARCELLO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8560
Country	:	US
Telephone Number	:	702-460-6648
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 W CHARLESTON BLVD STE 210
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1900
Country	:	US
Telephone Number	:	702-388-4428
Fax Number	:

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

Provider Enumeration Date	:	01/07/2019
Last Update Date	:	01/07/2019

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Directions to “ REYNALDA MAGDALENA GARCIA MENESES ” Practice Location

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