Healthcare Provider Details

I. General information

NPI: 1154556934
Provider Name (Legal Business Name): MICHELE ALISA DILAURO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 BANBURRY CROSS DR 130
LAS VEGAS NV
89144-7056
US

IV. Provider business mailing address

10050 BANBURRY CROSS DR 130
LAS VEGAS NV
89144-7056
US

V. Phone/Fax

Practice location:
  • Phone: 702-370-2172
  • Fax: 702-946-0866
Mailing address:
  • Phone: 702-370-2172
  • Fax: 702-946-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELE ALISA DILAURO
Title or Position: OWNER
Credential: MD
Phone: 702-370-2172