MEDICARE: DAISY OLAZABAL B.S. PSYCHOLOGY

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1184162521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY OLAZABAL B.S. PSYCHOLOGY

Provider Business Mailing Address
First Line	:	2255 RENAISSANCE DR
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6193
Country	:	US
Telephone Number	:	702-451-7542
Fax Number	:	702-450-4239

Provider Business Practice Location Address
First Line	:	2255 RENAISSANCE DR
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6193
Country	:	US
Telephone Number	:	702-451-7542
Fax Number	:	702-450-4239

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

Provider Enumeration Date	:	02/06/2017
Last Update Date	:	02/06/2017

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