MEDICARE: CASSIE MONTANA CEBREROS RDN, LD

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	133V00000X	Registered Dietitian	39945-DI-2	NV

General Provider Information

NPI Number	:	1861157521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE MONTANA CEBREROS RDN, LD

Provider Business Mailing Address
First Line	:	2905 LAKE EAST DR STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2384
Country	:	US
Telephone Number	:	702-742-2477
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 LAKE EAST DR STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2384
Country	:	US
Telephone Number	:	702-742-2477
Fax Number	:

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

Provider Enumeration Date	:	11/07/2021
Last Update Date	:	12/17/2025

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