Healthcare Provider Details

I. General information

NPI: 1346759255
Provider Name (Legal Business Name): MR. DARON DELVON GRIFFIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1472 S HIGHWAY 373
AMARGOSA VALLEY NV
89020-1514
US

IV. Provider business mailing address

5501 E HARMON AVE APT 159
LAS VEGAS NV
89122-5234
US

V. Phone/Fax

Practice location:
  • Phone: 775-372-1281
  • Fax:
Mailing address:
  • Phone: 435-720-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: