Healthcare Provider Details

I. General information

NPI: 1437731973
Provider Name (Legal Business Name): ALEXANDER DEQUITO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 MEADOW BRIDGE AVE
LAS VEGAS NV
89123-3649
US

IV. Provider business mailing address

2667 W RICHMAR AVE
LAS VEGAS NV
89123-3310
US

V. Phone/Fax

Practice location:
  • Phone: 702-955-7648
  • Fax:
Mailing address:
  • Phone: 702-955-7648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: