MEDICARE: MARICON AUSTRIA ANGAT

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1477844819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARICON AUSTRIA ANGAT

Provider Business Mailing Address
First Line	:	6458 MELVILLE GROVE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3642
Country	:	US
Telephone Number	:	702-431-4749
Fax Number	:

Provider Business Practice Location Address
First Line	:	6458 MELVILLE GROVE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3642
Country	:	US
Telephone Number	:	702-431-4749
Fax Number	:

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

Provider Enumeration Date	:	04/19/2011
Last Update Date	:	04/19/2011

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Directions to “ MARICON AUSTRIA ANGAT ” Practice Location

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