Individual
ADRIAN LICANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
820 RANCHO LN STE 40, LAS VEGAS, NV 89106-3806
(702) 366-0875
Mailing address
820 RANCHO LN STE 40, LAS VEGAS, NV 89106-3806
(702) 366-0875
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1705607801
IDENTIFICATION CARD
NV
Enumeration date
02/23/2018
Last updated
02/23/2018
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