Healthcare Provider Details

I. General information

NPI: 1588277610
Provider Name (Legal Business Name): CARL LITTLEJOHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 S NELLIS BLVD
LAS VEGAS NV
89121-7510
US

IV. Provider business mailing address

2110 E FLAMINGO RD STE 110
LAS VEGAS NV
89119-5191
US

V. Phone/Fax

Practice location:
  • Phone: 725-222-7203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: