Individual ProviderMayra MontijoNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1706 W Bonanza Rd, Las Vegas, NV 89106-4704(702) 631-6860PECOS EnrollmentBased on the most recent information from CMS, provider Mayra Montijo is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1659095735Provider TypeIndividualFull NameMontijo, MayraGenderFemaleSole ProprietorYesEnumeration Date10/3/2022Last Updated10/7/2022Contact InformationPractice LocationPractice Address1706 W Bonanza Rd, Las Vegas, NV 89106-4704Phone(702) 631-6860FaxUnlisted FaxMailing LocationMailing Address7085 Ipe Wood Rd, Las Vegas, NV 89148-5023PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense860498NevadaCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicense69268Nevada