Healthcare Provider Details

I. General information

NPI: 1891720694
Provider Name (Legal Business Name): DANIEL M. MAGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 S JONES BLVD
LAS VEGAS NV
89146-5306
US

IV. Provider business mailing address

2740 S JONES BLVD
LAS VEGAS NV
89146-5306
US

V. Phone/Fax

Practice location:
  • Phone: 702-248-8866
  • Fax: 702-248-1339
Mailing address:
  • Phone: 702-248-8866
  • Fax: 702-248-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLISW - 2925
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-9800
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: