Provider Demographics
NPI:1013539345
Name:ANDRES, MARCO ELI J
Entity Type:Individual
Prefix:
First Name:MARCO ELI
Middle Name:J
Last Name:ANDRES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 W WARM SPRINGS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-4326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1546 W WARM SPRINGS RD STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-4326
Practice Address - Country:US
Practice Address - Phone:702-565-5011
Practice Address - Fax:702-565-5012
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist