Healthcare Provider Details

I. General information

NPI: 1588824049
Provider Name (Legal Business Name): DONIELLE TWITTY-ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5615 S PECOS RD
LAS VEGAS NV
89120-1961
US

IV. Provider business mailing address

8485 BAROSSA CT
LAS VEGAS NV
89117-9158
US

V. Phone/Fax

Practice location:
  • Phone: 702-736-8100
  • Fax: 702-736-7881
Mailing address:
  • Phone: 702-736-8100
  • Fax: 702-736-7881

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: