MEDICARE: MR. DARWIN LUCAS EXEQUIEL TENORIO DONALDO MOT, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT-3419	NV

General Provider Information

NPI Number	:	1003609462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARWIN LUCAS EXEQUIEL TENORIO DONALDO MOT, OTR/L

Provider Business Mailing Address
First Line	:	6650 W WARM SPRINGS RD UNIT 2109
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4619
Country	:	US
Telephone Number	:	702-415-1376
Fax Number	:

Provider Business Practice Location Address
First Line	:	2580 MONTESSOURI ST STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3065
Country	:	US
Telephone Number	:	716-807-4179
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	05/27/2025

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