Provider Demographics
NPI:1275835266
Name:PILGRIM-CARROZZA, MARY MARIE
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARIE
Last Name:PILGRIM-CARROZZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 S RAINBOW BLVD # 276
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-6232
Mailing Address - Country:US
Mailing Address - Phone:702-202-6894
Mailing Address - Fax:702-202-6894
Practice Address - Street 1:1027 S RAINBOW BLVD # 276
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6232
Practice Address - Country:US
Practice Address - Phone:702-202-6894
Practice Address - Fax:702-202-6894
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner