Healthcare Provider Details

I. General information

NPI: 1952661704
Provider Name (Legal Business Name): DONNA EMELO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N TOWN CENTER DR STE 120
LAS VEGAS NV
89144-6302
US

IV. Provider business mailing address

4588 GRINDLE POINT ST
LAS VEGAS NV
89147-4700
US

V. Phone/Fax

Practice location:
  • Phone: 866-960-7691
  • Fax: 866-960-7692
Mailing address:
  • Phone: 650-892-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRC1864
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: