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NPI Code Detail

MEDICARE: JERU-MAALIK LOLLIS

MEDICARE: JERU-MAALIK LOLLIS
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1487145371
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERU-MAALIK LOLLIS
Provider Business Mailing Address
First Line : 3235 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89169-3310
Country : US
Telephone Number : 702-490-9009
Fax Number :
Provider Business Practice Location Address
First Line : 3235 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89169-3310
Country : US
Telephone Number : 702-490-9009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2018
Last Update Date : 05/25/2018

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Directions to “ JERU-MAALIK LOLLIS ” Practice Location

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