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NPI Code Detail

MEDICARE: MAYRA MONTIJO

MEDICARE: MAYRA MONTIJO
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
1163W00000XRegistered Nurse69268NV
2363LF0000XFamily Nurse Practitioner860498NV

General Provider Information

NPI Number : 1659095735
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAYRA MONTIJO
Provider Business Mailing Address
First Line : 7085 IPE WOOD RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-5023
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1706 W BONANZA RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4704
Country : US
Telephone Number : 702-631-6860
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2022
Last Update Date : 10/07/2022

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Directions to “ MAYRA MONTIJO ” Practice Location

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