Healthcare Provider Details

I. General information

NPI: 1215225834
Provider Name (Legal Business Name): LAS VEGAS OUTPATIENT REHABILITATION CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2011
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 S DECATUR BLVD
LAS VEGAS NV
89107-3931
US

IV. Provider business mailing address

534 S DECATUR BLVD
LAS VEGAS NV
89107-3931
US

V. Phone/Fax

Practice location:
  • Phone: 702-822-5814
  • Fax: 702-822-5816
Mailing address:
  • Phone: 702-822-5814
  • Fax: 702-822-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278P1005X
TaxonomyPulmonary Rehabilitation Certified Respiratory Therapist
License NumberRC651
License Number StateNV

VIII. Authorized Official

Name: DELSA DAGALEA
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 702-822-5814