Healthcare Provider Details

I. General information

NPI: 1336553171
Provider Name (Legal Business Name): DESERT PULMONARY REHABILITATION AND DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 S JONES BLVD STE 113
LAS VEGAS NV
89146-5607
US

IV. Provider business mailing address

2675 S JONES BLVD STE 113
LAS VEGAS NV
89146-5607
US

V. Phone/Fax

Practice location:
  • Phone: 702-665-4156
  • Fax: 702-749-3184
Mailing address:
  • Phone: 702-665-4156
  • Fax: 702-749-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOHN THAO
Title or Position: OWNER
Credential: RRT-SDS, BSN, RN
Phone: 702-665-4156