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General NPI Number Information
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NPI Number | 1184062309
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Entity Type | Individual
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Provider Name | JOHNATHAN RYAN TAITANO DO
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Gender | Male
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 2208 S NELLIS BLVD STE 5
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City | LAS VEGAS
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State | NV
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Zip | 89104-6211
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Country | US
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Telephone | 702-798-7770
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Fax | 702-895-7776
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Provider Business Mailing Address
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Address Line | 2610 S JONES BLVD STE 1
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City | LAS VEGAS
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State | NV
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Zip | 89146-5635
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Country | US
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Telephone | 702-723-8314
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Fax | 702-895-7776
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | DO2144
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | SL0955
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License Number State | NV
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