Healthcare Provider Details

I. General information

NPI: 1043728033
Provider Name (Legal Business Name): KAREEM JABRAUN GWINN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 W CHARLESTON BLVD
LAS VEGAS NV
89102-1859
US

IV. Provider business mailing address

3831 W CHARLESTON BLVD
LAS VEGAS NV
89102-1859
US

V. Phone/Fax

Practice location:
  • Phone: 702-876-1733
  • Fax:
Mailing address:
  • Phone: 702-876-1733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-0929
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: