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NPI Code Detail

MEDICARE: REGGIE ANDERSON

MEDICARE: REGGIE ANDERSON
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
1225400000XRehabilitation Practitioner
2172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1508169137
Entity Type Code : Individual
Provider Name (Legal Business Name) : REGGIE ANDERSON
Provider Business Mailing Address
First Line : 4278 CARTEGENA WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-6504
Country : US
Telephone Number : 702-283-0675
Fax Number :
Provider Business Practice Location Address
First Line : 4278 CARTEGENA WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-6504
Country : US
Telephone Number : 702-433-6468
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2010
Last Update Date : 01/28/2013

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Directions to “ REGGIE ANDERSON ” Practice Location

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