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NPI Code Detail

MEDICARE: DARRELL A LASANE BA

MEDICARE:   DARRELL A LASANE  BA
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
1225C00000XRehabilitation Counselor

General Provider Information

NPI Number : 1134517345
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARRELL A LASANE BA
Provider Business Mailing Address
First Line : 2917 VIGILANTE CT
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-6401
Country : US
Telephone Number : 702-308-4364
Fax Number : 702-778-9232
Provider Business Practice Location Address
First Line : 2917 VIGILANTE CT
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-6401
Country : US
Telephone Number : 702-308-4364
Fax Number : 702-778-9232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2014
Last Update Date : 02/03/2015

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Directions to “ DARRELL A LASANE BA” Practice Location

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