Healthcare Provider Details

I. General information

NPI: 1588086268
Provider Name (Legal Business Name): MR. MARQUIS BOXLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 N MARTIN LUTHER KING BLVD
NORTH LAS VEGAS NV
89032
US

IV. Provider business mailing address

5020 LONESOME SPUR AVE
LAS VEGAS NV
89131-5219
US

V. Phone/Fax

Practice location:
  • Phone: 702-502-9805
  • Fax:
Mailing address:
  • Phone: 702-782-7023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: