Provider Demographics
NPI:1265910368
Name:MANCILLA-RODRIGUEZ, MIRIAM XOCHITH
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:XOCHITH
Last Name:MANCILLA-RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 REYNOLDS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:N. LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030
Mailing Address - Country:US
Mailing Address - Phone:702-906-1999
Mailing Address - Fax:702-664-6933
Practice Address - Street 1:2415 REYNOLDS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:N. LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030
Practice Address - Country:US
Practice Address - Phone:702-906-1999
Practice Address - Fax:702-664-6933
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant