Basic Information
| Provider Information | |||||||||
| NPI: | 1699338756 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOLINA-MATRO | ||||||||
| FirstName: | MARITES | ||||||||
| MiddleName: | AYSON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 S RANCHO DR STE 12 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028771887 | ||||||||
| FaxNumber: | 7028774536 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S RANCHO DR STE 12 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028771887 | ||||||||
| FaxNumber: | 7028774536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2019 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 819298 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.