Basic Information
| Provider Information | |||||||||
| NPI: | 1649841388 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SANVICTORES | ||||||||
| FirstName: | CHARISSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4234 ABERNETHY FOREST PL | ||||||||
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| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891414337 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2250 E FLAMINGO RD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891195170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027844300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2021 | ||||||||
| LastUpdateDate: | 07/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 2709 | NV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.