MEDICARE: BENCY MARTY MANGLICMOT

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	372600000X	Adult Companion		NV

General Provider Information

NPI Number	:	1346123874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENCY MARTY MANGLICMOT

Provider Business Mailing Address
First Line	:	10629 CLEAR MEADOWS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-7363
Country	:	US
Telephone Number	:	702-360-1735
Fax Number	:	702-360-1735

Provider Business Practice Location Address
First Line	:	10629 CLEAR MEADOWS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-7363
Country	:	US
Telephone Number	:	702-360-1735
Fax Number	:	702-360-1735

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

Provider Enumeration Date	:	07/30/2025
Last Update Date	:	07/30/2025

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Directions to “ BENCY MARTY MANGLICMOT ” Practice Location

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