Healthcare Provider Details

I. General information

NPI: 1497006902
Provider Name (Legal Business Name): MICHAEL ANTHONY INTINARELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 E PATRICK LN SUITE 12
LAS VEGAS NV
89120-4932
US

IV. Provider business mailing address

3095 E PATRICK LN SUITE 12
LAS VEGAS NV
89120-4932
US

V. Phone/Fax

Practice location:
  • Phone: 702-483-5919
  • Fax: 702-483-5546
Mailing address:
  • Phone: 702-483-5919
  • Fax: 702-483-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: