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NPI Code Detail

MEDICARE: MR. DEANGELO DUBOIS COLE BST

MEDICARE: MR. DEANGELO DUBOIS COLE BST
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 PractitionerNV

General Provider Information

NPI Number : 1518209733
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DEANGELO DUBOIS COLE BST
Provider Business Mailing Address
First Line : 7577 BEVERLY HILLS DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-4981
Country : US
Telephone Number : 314-494-1376
Fax Number :
Provider Business Practice Location Address
First Line : 5175 CAMINO AL NORTE
Second Line : SUITE 100
City : NORTH LAS VEGAS
State : NV
Zip : 89031-2407
Country : US
Telephone Number : 702-648-3913
Fax Number : 702-868-8357
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2013
Last Update Date : 03/26/2013

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