Provider Demographics
NPI:1952903833
Name:PACUMBABA, MARIZ (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIZ
Middle Name:
Last Name:PACUMBABA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 LOSEE RD.
Mailing Address - Street 2:
Mailing Address - City:N. LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081
Mailing Address - Country:US
Mailing Address - Phone:702-383-3910
Mailing Address - Fax:702-383-7380
Practice Address - Street 1:5860 LOSEE RD.
Practice Address - Street 2:
Practice Address - City:N. LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081
Practice Address - Country:US
Practice Address - Phone:702-383-3910
Practice Address - Fax:702-383-7380
Is Sole Proprietor?:No
Enumeration Date:2020-11-14
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV835812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner