Provider Demographics
NPI:1689387318
Name:VERZONILLA, MICHELLE ANN DEL ROSARIO
Entity Type:Individual
Prefix:
First Name:MICHELLE ANN
Middle Name:DEL ROSARIO
Last Name:VERZONILLA
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 1:3660 SAINT ROSE PKWY UNIT 33102
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4876
Mailing Address - Country:US
Mailing Address - Phone:702-344-8412
Mailing Address - Fax:
Practice Address - Street 1:3160 W SAHARA AVE STE A11
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-3215
Practice Address - Country:US
Practice Address - Phone:702-900-5616
Practice Address - Fax:702-446-6586
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner