MEDICARE: JUSTAN DEGENEFFE

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	2080P0006X	Developmental - Behavioral Pediatrics Physician	181456	NV

General Provider Information

NPI Number	:	1770132466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTAN DEGENEFFE

Provider Business Mailing Address
First Line	:	7676 SILVER BARON RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89179-2070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7676 SILVER BARON RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89179-2070
Country	:	US
Telephone Number	:	702-406-2325
Fax Number	:

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

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	05/18/2026

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Directions to “ JUSTAN DEGENEFFE ” Practice Location

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