Healthcare Provider Details

I. General information

NPI: 1689919771
Provider Name (Legal Business Name): MR. TYREEK E JARMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 E BONANZA RD SUITE 101
LAS VEGAS NV
89110-2198
US

IV. Provider business mailing address

3551 E BONANZA RD SUITE 101
LAS VEGAS NV
89110-2198
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-9355
  • Fax:
Mailing address:
  • Phone: 702-240-9355
  • Fax:

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: