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General NPI Number Information
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NPI Number | 1154556934
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Entity Type | Organization
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Legal Business Name | MICHELE ALISA DILAURO MD PC
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Dates
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Enumeration Date | 05/21/2009
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 10050 BANBURRY CROSS DR 130
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City | LAS VEGAS
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State | NV
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Zip | 89144-7056
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Country | US
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Telephone | 702-370-2172
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Fax | 702-946-0866
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Provider Business Mailing Address
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Address Line | 10050 BANBURRY CROSS DR 130
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City | LAS VEGAS
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State | NV
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Zip | 89144-7056
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Country | US
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Telephone | 702-370-2172
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Fax | 702-946-0866
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELE ALISA DILAURO
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Credential | MD
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Telephone | 702-370-2172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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