Provider Demographics
NPI:1164833638
Name:PENA SARIOL, DAVID M (CMT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:PENA SARIOL
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4416
Mailing Address - Country:US
Mailing Address - Phone:702-901-4000
Mailing Address - Fax:702-445-7620
Practice Address - Street 1:4550 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5525
Practice Address - Country:US
Practice Address - Phone:702-901-4000
Practice Address - Fax:702-445-7620
Is Sole Proprietor?:No
Enumeration Date:2014-05-18
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT6718225700000X
FLMA61455225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist