Individual ProviderMonique ProvencioCommunity/Behavioral HealthAgenciesPractice Address2725 S Jones Blvd, Suite 109, Las Vegas, NV 89146-5667(702) 758-2992PECOS EnrollmentBased on the most recent information from CMS, provider Monique Provencio does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1346618154Provider TypeIndividualFull NameProvencio, MoniqueGenderFemaleSole ProprietorYesEnumeration Date9/10/2015Last Updated4/3/2017Contact InformationPractice LocationPractice Address2725 S Jones Blvd, Suite 109, Las Vegas, NV 89146-5667Phone(702) 758-2992Fax(702) 829-2876Mailing LocationMailing Address2725 S Jones Blvd, Suite 109, Las Vegas, NV 89146-5667Phone(702) 758-2992Fax(702) 829-2876Provider TaxonomiesCodeDescriptionLicenseCode251S00000XPrimaryDescriptionCommunity/Behavioral HealthAgenciesLicenseUnlisted Issuer