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NPI Code Detail

MEDICARE: MRS. ADA ENID DELVALLE PTA

MEDICARE: MRS. ADA ENID DELVALLE PTA
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
1225200000XPhysical Therapy AssistantA-0439NV

General Provider Information

NPI Number : 1538282314
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ADA ENID DELVALLE PTA
Provider Business Mailing Address
First Line : 3429 VISIONARY BAY AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-6514
Country : US
Telephone Number : 702-642-9458
Fax Number :
Provider Business Practice Location Address
First Line : 2170 E HARMON AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-7840
Country : US
Telephone Number : 702-794-0100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. ADA ENID DELVALLE PTA” Practice Location

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