Provider Demographics
NPI:1366934481
Name:RICH-MAZZEO, PLLC
Entity type:Organization
Organization Name:RICH-MAZZEO, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANJARRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-683-3833
Mailing Address - Street 1:1321 N MCCARRAN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-3873
Mailing Address - Country:US
Mailing Address - Phone:775-683-3833
Mailing Address - Fax:775-683-3831
Practice Address - Street 1:1321 N MCCARRAN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-3873
Practice Address - Country:US
Practice Address - Phone:775-870-3093
Practice Address - Fax:775-800-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV002280364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty