Provider Demographics
NPI:1417302787
Name:SANEZ, RICHELL GRACE VALDEZ
Entity Type:Individual
Prefix:MS
First Name:RICHELL GRACE
Middle Name:VALDEZ
Last Name:SANEZ
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 1:600 S TONOPAH DR STE 350
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4040
Mailing Address - Country:US
Mailing Address - Phone:702-384-6330
Mailing Address - Fax:702-384-2668
Practice Address - Street 1:600 S TONOPAH DR STE 350
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4040
Practice Address - Country:US
Practice Address - Phone:702-384-6330
Practice Address - Fax:702-384-2668
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT295916225100000X
NV3944225100000X
NM4348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1417302787Medicaid