Provider Demographics
NPI:1225405020
Name:AMARANTO, IAN
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:AMARANTO
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 1:2900 SUNRDG HGTS
Mailing Address - Street 2:PARKWAY UNIT #1122
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4470
Mailing Address - Country:US
Mailing Address - Phone:702-523-5804
Mailing Address - Fax:702-855-3384
Practice Address - Street 1:2900 SUNRDG HGTS
Practice Address - Street 2:PARKWAY UNIT #1122
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4470
Practice Address - Country:US
Practice Address - Phone:702-523-5804
Practice Address - Fax:702-855-3384
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No101Y00000XBehavioral Health & Social Service ProvidersCounselor