Provider Demographics
NPI:1710733431
Name:REYES PACHECO, MARILIN
Entity type:Individual
Prefix:
First Name:MARILIN
Middle Name:
Last Name:REYES PACHECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 TRANSVERSE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1167
Mailing Address - Country:US
Mailing Address - Phone:702-722-1229
Mailing Address - Fax:
Practice Address - Street 1:6150 TRANSVERSE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1167
Practice Address - Country:US
Practice Address - Phone:702-722-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant