Individual
PACIENCIA MANTE ILUSTRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3431 VILLA HERMOSA DR, LAS VEGAS, NV 89121-4022
(702) 325-4512
Mailing address
3431 VILLA HERMOSA DR, LAS VEGAS, NV 89121-4022
(702) 325-4352
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
05/15/2013
Last updated
05/15/2013
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