MEDICARE: DIANE BARGINEAR

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	225400000X	Rehabilitation Practitioner
3	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1386189843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE BARGINEAR

Provider Business Mailing Address
First Line	:	4312 CRIMSON TIDE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0445
Country	:	US
Telephone Number	:	313-412-7738
Fax Number	:

Provider Business Practice Location Address
First Line	:	4312 CRIMSON TIDE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0445
Country	:	US
Telephone Number	:	313-412-7738
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	12/19/2016

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Directions to “ DIANE BARGINEAR ” Practice Location

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