MEDICARE: MAYRA ELIZABETH SANTOS

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	101YP2500X	Professional Counselor	CP5758	NV

General Provider Information

NPI Number	:	1912503079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRA ELIZABETH SANTOS

Provider Business Mailing Address
First Line	:	981 WHITNEY RANCH DR APT 1425
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-2573
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6655 W SAHARA AVE STE C203
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0850
Country	:	US
Telephone Number	:	702-900-2784
Fax Number	:

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

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/24/2024

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