Individual
GREGORY MANNARINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7061 GRAND MONTECITO PKWY, LAS VEGAS, NV 89149-0287
(702) 750-3900
(702) 750-3916
Mailing address
PO BOX 15645, LAS VEGAS, NV 89114-5645
(702) 750-3900
(702) 750-3916
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006088-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487670998
—
NV
01
—
PA1162
NV STATE LICENSE
NV
Enumeration date
07/15/2006
Last updated
02/14/2014
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