Provider Demographics
NPI:1942068390
Name:REPETTO, MAYRA CAMILLE
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:CAMILLE
Last Name:REPETTO
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 1:625 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4118
Mailing Address - Country:US
Mailing Address - Phone:801-657-2280
Mailing Address - Fax:
Practice Address - Street 1:625 SHADOW LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4118
Practice Address - Country:US
Practice Address - Phone:801-657-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program