Provider Demographics
NPI:1750069803
Name:VIZCAINO, SABRINA (MT)
Entity type:Individual
Prefix:MRS
First Name:SABRINA
Middle Name:
Last Name:VIZCAINO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7354 GLOWING POINT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-4747
Mailing Address - Country:US
Mailing Address - Phone:505-803-6208
Mailing Address - Fax:
Practice Address - Street 1:7354 GLOWING POINT ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-4747
Practice Address - Country:US
Practice Address - Phone:505-803-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT12058225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist