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NPI Code Detail

MEDICARE: CAMILLE MARRERO MANGUAL PTA

MEDICARE: CAMILLE MARRERO MANGUAL PTA
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
1225200000XPhysical Therapy AssistantA-1194NV

General Provider Information

NPI Number : 1679139810
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMILLE MARRERO MANGUAL PTA
Provider Business Mailing Address
First Line : 6402 RUSTICATED STONE AVE UNIT 102
Second Line :
City : HENDERSON
State : NV
Zip : 89011-1669
Country : US
Telephone Number : 702-628-6862
Fax Number :
Provider Business Practice Location Address
First Line : 2080 E FLAMINGO RD STE 111
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5175
Country : US
Telephone Number : 702-737-8820
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2019
Last Update Date : 05/14/2019

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Directions to “ CAMILLE MARRERO MANGUAL PTA” Practice Location

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