Healthcare Provider Details

I. General information

NPI: 1275947061
Provider Name (Legal Business Name): AARON ILABAN CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8685 S EASTERN AVE
LAS VEGAS NV
89123-2839
US

IV. Provider business mailing address

8685 S EASTERN AVE
LAS VEGAS NV
89123-2839
US

V. Phone/Fax

Practice location:
  • Phone: 702-914-1398
  • Fax: 702-914-1399
Mailing address:
  • Phone: 702-914-1398
  • Fax: 702-914-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278P1005X
TaxonomyPulmonary Rehabilitation Certified Respiratory Therapist
License NumberRC2375
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: