Individual provider Active NPI

Alyza Grace Mijares, MS, OTR/L

  • Occupational Therapist
  • Las Vegas, NV
National Provider Identifier
1336760610
Registry record updated Apr 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT-2477 Issued in NV
Practice address
2012 S Jones Blvd
Las Vegas, NV 89146-3151
Phone
(702) 360-1137
NPI assigned
Apr 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT-2477 NV Primary

Addresses

Primary practice location

2012 S Jones Blvd
Las Vegas, NV 89146-3151

Mailing address

7812 Paper Flower CT
Las Vegas, NV 89128-7328
Phone (702) 321-1973

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231101001126 NV Practitioner - Occupational Therapist in Private Practice 8224484993 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

7540 Smoke Ranch Rd
Las Vegas, NV 89128-0392
Phone (702) 337-2480

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Select Rehabilitation, LLC Occupational Therapist CurrentSince Aug 12, 2023 Accepting new patients

Locations

7540 Smoke Ranch Rd
Las Vegas, NV 89128
Phone (702) 337-2480

6660 Grand Montecito Pkwy
Las Vegas, NV 89149
Phone (775) 347-7901

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1588032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588032000000",
    "number": "1336760610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7812 PAPER FLOWER CT",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891287328",
            "telephone_number": "702-321-1973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2012 S JONES BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891463151",
            "telephone_number": "702-360-1137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIJARES",
        "first_name": "ALYZA GRACE",
        "credential": "MS, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-28",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NV",
            "license": "OT-2477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.