Healthcare Provider Details

I. General information

NPI: 1306351291
Provider Name (Legal Business Name): MYRA PHUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7261 W CHARLESTON BLVD STE 101
LAS VEGAS NV
89117-1679
US

IV. Provider business mailing address

7948 SANDROCK RANCH ST
LAS VEGAS NV
89113-3068
US

V. Phone/Fax

Practice location:
  • Phone: 702-396-0101
  • Fax:
Mailing address:
  • Phone: 702-768-8998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2639
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: