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NPI Code Detail

MEDICARE: MR. DAMON MATTISON JR.

MEDICARE: MR. DAMON MATTISON JR.
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

General Provider Information

NPI Number : 1619281474
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAMON MATTISON JR.
Provider Business Mailing Address
First Line : 7100 W ALEXANDER RD APT 2081
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-1713
Country : US
Telephone Number : 313-575-0848
Fax Number :
Provider Business Practice Location Address
First Line : 2475 W CHEYENNE AVE STE 130
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-4329
Country : US
Telephone Number : 702-646-7570
Fax Number : 702-974-1348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2010
Last Update Date : 08/03/2010

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Directions to “ MR. DAMON MATTISON JR. ” Practice Location

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