Healthcare Provider Details

I. General information

NPI: 1124571153
Provider Name (Legal Business Name): DAREN DWAYNE HAMBLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S RAINBOW BLVD 1
LAS VEGAS NV
89145-5362
US

IV. Provider business mailing address

6300 MCCARRAN ST 2014
NORTH LAS VEGAS NV
89081-8135
US

V. Phone/Fax

Practice location:
  • Phone: 702-778-8922
  • Fax:
Mailing address:
  • Phone: 702-427-1792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: