Provider Demographics
NPI:1114481785
Name:MARIANO, RUEL (NP)
Entity Type:Individual
Prefix:MR
First Name:RUEL
Middle Name:
Last Name:MARIANO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1829
Mailing Address - Country:US
Mailing Address - Phone:702-971-2300
Mailing Address - Fax:702-903-4447
Practice Address - Street 1:3750 S JONES BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2209
Practice Address - Country:US
Practice Address - Phone:702-444-7744
Practice Address - Fax:702-444-7898
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV816895363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care