Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1083958326 |
---|---|
Provider Name | Alexis Marie Medel |
First Address | Las Vegas, NV 89128-0560 |
Second Address | Las Vegas, NV 89128-0560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2012 |
Last Update Date | 26/11/2012 |