Healthcare Provider Details

I. General information

NPI: 1033932967
Provider Name (Legal Business Name): SAMANTHA RAY DAO-WHITTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5460 W SAHARA AVE
LAS VEGAS NV
89146-3307
US

IV. Provider business mailing address

5460 W SAHARA AVE
LAS VEGAS NV
89146-3307
US

V. Phone/Fax

Practice location:
  • Phone: 702-216-8900
  • Fax: 702-216-8965
Mailing address:
  • Phone: 702-216-8900
  • Fax: 702-216-8965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9955-M
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: