Provider Demographics
NPI:1346123874
Name:MANGLICMOT, BENCY MARTY
Entity type:Individual
Prefix:
First Name:BENCY
Middle Name:MARTY
Last Name:MANGLICMOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10629 CLEAR MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-7363
Mailing Address - Country:US
Mailing Address - Phone:702-360-1735
Mailing Address - Fax:702-360-1735
Practice Address - Street 1:10629 CLEAR MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-7363
Practice Address - Country:US
Practice Address - Phone:702-360-1735
Practice Address - Fax:702-360-1735
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty