Healthcare Provider Details

I. General information

NPI: 1447650486
Provider Name (Legal Business Name): DESERT PULMONARY REHABILITATION AND DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 S JONES BLVD STE C
LAS VEGAS NV
89146-5657
US

IV. Provider business mailing address

2980 S JONES BLVD STE C
LAS VEGAS NV
89146-5657
US

V. Phone/Fax

Practice location:
  • Phone: 702-487-5511
  • Fax: 702-487-5211
Mailing address:
  • Phone: 702-487-5511
  • Fax: 702-487-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRC346
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRC1453
License Number StateNV

VIII. Authorized Official

Name: JOHN THAO
Title or Position: MANAGING DIRECTOR
Credential: BA, RRT, RRT-SDS
Phone: 702-487-5511