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General NPI Number Information
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NPI Number | 1083263362
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Entity Type | Individual
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Provider Name | JOSE CARLOS TREJO CARDOSO
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Gender | Male
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 3925 N MLK BLVD
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-7673
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Country | US
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Telephone | 702-461-1982
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Fax | 702-476-1191
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Provider Business Mailing Address
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Address Line | 3925 N MLK BLVD STE 212
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-7676
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Country | US
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Telephone | 702-461-1982
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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