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NPI Code Detail

MEDICARE: ELIJAH LAMAR DAVIS

MEDICARE: ELIJAH LAMAR DAVIS
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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1437894086
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIJAH LAMAR DAVIS
Provider Business Mailing Address
First Line : 1900 E TROPICANA AVE APT 141
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-6535
Country : US
Telephone Number : 702-287-4335
Fax Number :
Provider Business Practice Location Address
First Line : 1775 E TROPICANA AVE STE 16B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-6557
Country : US
Telephone Number : 702-405-9565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2022
Last Update Date : 04/28/2022

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Directions to “ ELIJAH LAMAR DAVIS ” Practice Location

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