Healthcare Provider Details

I. General information

NPI: 1285917989
Provider Name (Legal Business Name): EDEN MARIE A TAPAT RT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N TOWN CENTER DR SUITE 120
LAS VEGAS NV
89144-6301
US

IV. Provider business mailing address

1120 N TOWN CENTER DR SUITE 120
LAS VEGAS NV
89144-6301
US

V. Phone/Fax

Practice location:
  • Phone: 808-520-7895
  • Fax:
Mailing address:
  • Phone: 808-520-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRC1932
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: