MEDICARE: GERARDO A MARIANO

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	3104A0625X	Assisted Living Facility (Mental Illness)	297-AGC-32	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366001950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARDO A MARIANO

Provider Business Mailing Address
First Line	:	4462 FARMCREST DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4906
Country	:	US
Telephone Number	:	702-433-2879
Fax Number	:	702-433-2879

Provider Business Practice Location Address
First Line	:	4462 FARMCREST DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4906
Country	:	US
Telephone Number	:	702-433-2879
Fax Number	:

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

Provider Enumeration Date	:	06/07/2019
Last Update Date	:	06/07/2019

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Directions to “ GERARDO A MARIANO ” Practice Location

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