Healthcare Provider Details

I. General information

NPI: 1528483112
Provider Name (Legal Business Name): ALICIA DYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 E PATRICK LN STE 1
LAS VEGAS NV
89120-3481
US

IV. Provider business mailing address

370 CASA NORTE DR UNIT 2149
N LAS VEGAS NV
89031-3333
US

V. Phone/Fax

Practice location:
  • Phone: 702-992-0576
  • Fax:
Mailing address:
  • Phone: 702-299-5624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: