Healthcare Provider Details

I. General information

NPI: 1225452188
Provider Name (Legal Business Name): TAITIANA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 E. MT CHARLESTON DR. SO UNIT A
PAHRUMP NV
89048
US

IV. Provider business mailing address

1291 E. MT CHARLESTON DR. SO #A
PAHRUMP NV
89048
US

V. Phone/Fax

Practice location:
  • Phone: 702-534-8863
  • Fax:
Mailing address:
  • Phone: 702-534-8863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: