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NPI Code Detail

MEDICARE: SHIBA AMEZCUA

MEDICARE: SHIBA AMEZCUA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1770939266
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHIBA AMEZCUA
Provider Business Mailing Address
First Line : 5258 S EASTERN AVE STE 105
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2327
Country : US
Telephone Number : 702-464-5080
Fax Number :
Provider Business Practice Location Address
First Line : 5258 S EASTERN AVE STE 105
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2327
Country : US
Telephone Number : 702-464-5080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2016
Last Update Date : 05/13/2016

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Directions to “ SHIBA AMEZCUA ” Practice Location

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