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General NPI Number Information
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NPI Number | 1366738411
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Entity Type | Individual
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Provider Name | MR. DARAYON DAVON JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 2349 RENAISSANCE DR SUITE A
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City | LAS VEGAS
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State | NV
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Zip | 89119-6191
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Country | US
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Telephone | 702-739-7716
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Fax |
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Provider Business Mailing Address
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Address Line | 6236 DIAZO ST
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-1727
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Country | US
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Telephone | 702-376-7914
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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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