Healthcare Provider Details

I. General information

NPI: 1568228260
Provider Name (Legal Business Name): PIERRE MIKAEL LAVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S MARTIN LUTHER KING BLVD
LAS VEGAS NV
89106-4413
US

IV. Provider business mailing address

11242 AURORA COVE CT
LAS VEGAS NV
89179-2008
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-5580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1544
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: