Healthcare Provider Details

I. General information

NPI: 1902294846
Provider Name (Legal Business Name): DRANREB ESPURA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 W CHARLESTON BLVD
LAS VEGAS NV
89102-2223
US

IV. Provider business mailing address

3061 BELLA VERONA AVE
LAS VEGAS NV
89141-3531
US

V. Phone/Fax

Practice location:
  • Phone: 702-386-7980
  • Fax:
Mailing address:
  • Phone: 702-883-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2021
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: