MEDICARE: MR. DARRYL TATE

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
1	251E00000X	Home Health Agency	E18332082021-5	NV

General Provider Information

NPI Number	:	1609535350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARRYL TATE

Provider Business Mailing Address
First Line	:	3800 DALECREST DR UNIT 2052
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-1767
Country	:	US
Telephone Number	:	562-824-9879
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 DALECREST DR UNIT 2052
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-1767
Country	:	US
Telephone Number	:	562-824-9879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2021
Last Update Date	:	12/09/2021

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