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NPI Code Detail

MEDICARE: LEVI DERRELL BOYKIN

MEDICARE: LEVI DERRELL BOYKIN
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 : 1679867618
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEVI DERRELL BOYKIN
Provider Business Mailing Address
First Line : 5150 S PECOS RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-1237
Country : US
Telephone Number : 702-483-5919
Fax Number : 702-483-5546
Provider Business Practice Location Address
First Line : 5150 S PECOS RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-1237
Country : US
Telephone Number : 702-483-5919
Fax Number : 702-483-5546
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2011
Last Update Date : 06/07/2011

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Directions to “ LEVI DERRELL BOYKIN ” Practice Location

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