MEDICARE: LA'VAR MAR'QIES PORTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	225400000X	Rehabilitation Practitioner
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1437586674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LA'VAR MAR'QIES PORTER

Provider Business Mailing Address
First Line	:	2449 N TENAYA WAY # 33901
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9995
Country	:	US
Telephone Number	:	702-337-6432
Fax Number	:

Provider Business Practice Location Address
First Line	:	1956 DWARF STAR DR APT 2034
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-6244
Country	:	US
Telephone Number	:	702-337-6432
Fax Number	:

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

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	03/28/2022

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Directions to “ LA'VAR MAR'QIES PORTER ” Practice Location

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