Individual
MIGUEL ANTONACCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5969 VIZZI CT, LAS VEGAS, NV 89131-2858
(702) 830-2481
Mailing address
6512 N DECATUR BLVD STE 130-114, LAS VEGAS, NV 89131-1046
(702) 830-2481
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/21/2014
Last updated
02/21/2014
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