MEDICARE: MRS. ROWENA SANTOS LAINO M.S.

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	101YM0800X	Mental Health Counselor	3192	NV
2	171400000X	Health & Wellness Coach	3192	NV
3	106H00000X	Marriage & Family Therapist	3192	NV

General Provider Information

NPI Number	:	1578840070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROWENA SANTOS LAINO M.S.

Provider Business Mailing Address
First Line	:	12232 SEA VOYAGE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-4606
Country	:	US
Telephone Number	:	702-340-9188
Fax Number	:

Provider Business Practice Location Address
First Line	:	12232 SEA VOYAGE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-4606
Country	:	US
Telephone Number	:	702-340-9188
Fax Number	:

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

Provider Enumeration Date	:	11/11/2011
Last Update Date	:	08/31/2021

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