Provider Demographics
NPI:1134286602
Name:SANGRIA, MARVIN DOMINGUEZ (RPT)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:DOMINGUEZ
Last Name:SANGRIA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 W ARBY AVE
Mailing Address - Street 2:# 288
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4656
Mailing Address - Country:US
Mailing Address - Phone:702-480-4215
Mailing Address - Fax:702-898-6470
Practice Address - Street 1:5400 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-853-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist