Healthcare Provider Details

I. General information

NPI: 1740780790
Provider Name (Legal Business Name): ALAN ADL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2477 RANGE CREEK ST
HENDERSON NV
89044-1602
US

IV. Provider business mailing address

2477 RANGE CREEK ST
HENDERSON NV
89044-1602
US

V. Phone/Fax

Practice location:
  • Phone: 714-915-1337
  • Fax:
Mailing address:
  • Phone: 714-915-1337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: