Healthcare Provider Details

I. General information

NPI: 1689979940
Provider Name (Legal Business Name): SUZANNE DAVIS QHMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. SUZANNE MOORE

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 S PECOS RD
LAS VEGAS NV
89120-1237
US

IV. Provider business mailing address

3255 CASEY DR APT 202
LAS VEGAS NV
89120-1164
US

V. Phone/Fax

Practice location:
  • Phone: 702-483-5919
  • Fax: 702-483-5546
Mailing address:
  • Phone: 702-622-6424
  • 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: