MEDICARE: MS. PENNY NUNEZ MCDONOUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	103K00000X	Behavior Analyst
2	175T00000X	Peer Specialist	CA
3	251B00000X	Case Management Agency
4	3747P1801X	Personal Care Attendant
5	374U00000X	Home Health Aide
6	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780008938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PENNY NUNEZ MCDONOUGH

Provider Business Mailing Address
First Line	:	6550 S PECOS RD STE B-115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2828
Country	:	US
Telephone Number	:	415-690-6635
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 S PECOS RD STE B-115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2828
Country	:	US
Telephone Number	:	415-690-6635
Fax Number	:

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

Provider Enumeration Date	:	02/08/2014
Last Update Date	:	11/27/2023

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