MEDICARE: DORAL ACADEMY OF NEVADA

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
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1689311078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORAL ACADEMY OF NEVADA

Provider Business Mailing Address
First Line	:	610 CROSSBRIDGE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6113
Country	:	US
Telephone Number	:	702-776-8740
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 CROSSBRIDGE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6113
Country	:	US
Telephone Number	:	702-776-8740
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF SPECIAL PROJECTS
Name	:	CRYSTAL THIRIOT
Credential	:
Telephone Number	:	702-423-3348

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	05/17/2022

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