Healthcare Provider Details

I. General information

NPI: 1134003338
Provider Name (Legal Business Name): ALEXANDER J JANTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6345 S JONES BLVD STE 300
LAS VEGAS NV
89118-3334
US

IV. Provider business mailing address

324 WHITNEY BREEZE AVE
NORTH LAS VEGAS NV
89031-6880
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-4009
  • Fax:
Mailing address:
  • Phone: 702-806-3709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3707
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: