MEDICARE: IFAKOLADE O.D.I. REECE

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	101YP1600X	Pastoral Counselor		NV

General Provider Information

NPI Number	:	1326309246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IFAKOLADE O.D.I. REECE

Provider Business Mailing Address
First Line	:	5070 VEGAS VALLEY DR UNIT 621804
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89162-8882
Country	:	US
Telephone Number	:	702-371-3823
Fax Number	:

Provider Business Practice Location Address
First Line	:	5070 VEGAS VALLEY DR UNIT 621804
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89162-8882
Country	:	US
Telephone Number	:	702-371-3823
Fax Number	:

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

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	04/22/2024

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