Individual provider Active NPI

Alyssa-Reece Mangonon Ganotisi

  • Specialist
  • N Las Vegas, NV
National Provider Identifier
1033045497
Registry record updated Jun 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Practice address
5413 Pride Mountain St
N Las Vegas, NV 89031-7850
Phone
(808) 517-7942
NPI assigned
Jun 22, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NV Primary

Addresses

Primary practice location

5413 Pride Mountain St
N Las Vegas, NV 89031-7850

Mailing address

5413 Pride Mountain St
N Las Vegas, NV 89031-7850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1782086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782086400000",
    "number": "1033045497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5413 PRIDE MOUNTAIN ST",
            "city": "N LAS VEGAS",
            "state": "NV",
            "postal_code": "890317850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5413 PRIDE MOUNTAIN ST",
            "city": "N LAS VEGAS",
            "state": "NV",
            "postal_code": "890317850",
            "telephone_number": "808-517-7942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANOTISI",
        "first_name": "ALYSSA-REECE",
        "middle_name": "MANGONON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-06-22",
        "last_updated": "2026-06-22",
        "certification_date": "2026-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in N Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.