MEDICARE: MARIANA AWNI TADROS

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1164194023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANA AWNI TADROS

Provider Business Mailing Address
First Line	:	5801 W CRAIG RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2504
Country	:	US
Telephone Number	:	725-251-2253
Fax Number	:	725-251-2646

Provider Business Practice Location Address
First Line	:	5801 W CRAIG RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2504
Country	:	US
Telephone Number	:	725-251-2253
Fax Number	:	725-251-2646

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

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	09/29/2021

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