MEDICARE: MAYULIS MONTALVAN SOTOLONGO RN

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	103K00000X	Behavior Analyst
2	101Y00000X	Counselor
3	163W00000X	Registered Nurse	861542	NV

General Provider Information

NPI Number	:	1831571835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYULIS MONTALVAN SOTOLONGO RN

Provider Business Mailing Address
First Line	:	2392 GRANNIS LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5087
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2950 E FLAMINGO RD STE H
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5208
Country	:	US
Telephone Number	:	725-251-3854
Fax Number	:

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

Provider Enumeration Date	:	06/25/2015
Last Update Date	:	02/05/2024

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