Healthcare Provider Details

I. General information

NPI: 1235911470
Provider Name (Legal Business Name): SOMMER ELIZABETH DILLER MED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4285 N RANCHO DR STE 160
LAS VEGAS NV
89130-3456
US

IV. Provider business mailing address

4655 N CHIEFTAIN ST
LAS VEGAS NV
89129-2610
US

V. Phone/Fax

Practice location:
  • Phone: 702-767-6331
  • Fax:
Mailing address:
  • Phone: 702-767-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: