Provider Demographics
NPI:1073802757
Name:REZENDE, MARCIO
Entity Type:Individual
Prefix:
First Name:MARCIO
Middle Name:
Last Name:REZENDE
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 1:7040 LAREDO ST STE K
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3044
Mailing Address - Country:US
Mailing Address - Phone:702-331-4874
Mailing Address - Fax:
Practice Address - Street 1:7040 LAREDO ST STE K
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3044
Practice Address - Country:US
Practice Address - Phone:702-331-4874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01319106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist