MEDICARE: REHAB DIRECTIVES LLC

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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1104214055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHAB DIRECTIVES LLC

Provider Business Mailing Address
First Line	:	3165 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4578
Country	:	US
Telephone Number	:	702-570-6222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3165 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4578
Country	:	US
Telephone Number	:	702-570-6222
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MR. DONATO BALTAZAR LAZA
Credential	:	OTR
Telephone Number	:	702-499-3764

Provider Enumeration Date	:	12/30/2014
Last Update Date	:	10/22/2024

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Directions to “REHAB DIRECTIVES LLC ” Practice Location

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