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NPI Code Detail

MEDICARE: MR. BENJAMIN HIRABAYASHI ATC, LAT

MEDICARE: MR. BENJAMIN HIRABAYASHI ATC, LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer0506273NV

General Provider Information

NPI Number : 1063954865
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BENJAMIN HIRABAYASHI ATC, LAT
Provider Business Mailing Address
First Line : 9533 BORGATA BAY BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-8011
Country : US
Telephone Number : 702-300-4255
Fax Number :
Provider Business Practice Location Address
First Line : 6510 HINSON ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-4413
Country : US
Telephone Number : 702-300-4255
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2016
Last Update Date : 11/09/2016

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