MEDICARE: JUAN MIGUEL INFANTADO

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	225200000X	Physical Therapy Assistant	A-1274	NV

General Provider Information

NPI Number	:	1730944190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN MIGUEL INFANTADO

Provider Business Mailing Address
First Line	:	6758 LAVENDER SKY CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-3647
Country	:	US
Telephone Number	:	702-416-4630
Fax Number	:

Provider Business Practice Location Address
First Line	:	3215 E CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4235
Country	:	US
Telephone Number	:	702-649-7800
Fax Number	:

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

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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