Healthcare Provider Details

I. General information

NPI: 1740542976
Provider Name (Legal Business Name): NORMANDY JOSE EQUI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 S MARYLAND PKWY STE 310
LAS VEGAS NV
89109-1566
US

IV. Provider business mailing address

5132 PEBBLE BEACH BLVD APT C
LAS VEGAS NV
89108-1439
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-3800
  • Fax: 702-240-3001
Mailing address:
  • Phone: 702-648-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: