Healthcare Provider Details

I. General information

NPI: 1184378044
Provider Name (Legal Business Name): ABDUL SHALAMAR MOSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 NERO AVE
LAS VEGAS NV
89183-7001
US

IV. Provider business mailing address

924 NERO AVE
LAS VEGAS NV
89183-7001
US

V. Phone/Fax

Practice location:
  • Phone: 702-815-3748
  • Fax:
Mailing address:
  • Phone: 702-815-3748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: