Provider Demographics
NPI:1568968873
Name:PACAS-INTERIANO, MANDY LYN MARIE
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:LYN MARIE
Last Name:PACAS-INTERIANO
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 1:601 S RANCHO DR STE A7
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4898
Mailing Address - Country:US
Mailing Address - Phone:702-386-0254
Mailing Address - Fax:702-386-0276
Practice Address - Street 1:601 S RANCHO DR STE A7
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4898
Practice Address - Country:US
Practice Address - Phone:702-386-0254
Practice Address - Fax:702-386-0276
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst