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NPI Code Detail

MEDICARE: LONG LA

MEDICARE: LONG LA
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 : 1538544689
Entity Type Code : Individual
Provider Name (Legal Business Name) : LONG LA
Provider Business Mailing Address
First Line : 5000 RED ROCK ST APT 266
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-1283
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5000 RED ROCK ST APT 266
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-1283
Country : US
Telephone Number : 702-929-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2015
Last Update Date : 07/29/2015

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Directions to “ LONG LA ” Practice Location

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