Healthcare Provider Details

I. General information

NPI: 1699318436
Provider Name (Legal Business Name): ANGELLIA GRIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 S PECOS RD
LAS VEGAS NV
89121-6038
US

IV. Provider business mailing address

4760 S PECOS RD
LAS VEGAS NV
89121-6038
US

V. Phone/Fax

Practice location:
  • Phone: 702-601-2697
  • Fax:
Mailing address:
  • Phone:
  • 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: