MEDICARE: MICHAEL STAPLES II

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1710442330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL STAPLES II

Provider Business Mailing Address
First Line	:	3435 W CRAIG RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7816 GOLDEN TALON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-8218
Country	:	US
Telephone Number	:	310-722-3988
Fax Number	:

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

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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Directions to “ MICHAEL STAPLES II ” Practice Location

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