MEDICARE: ISAIAH LAFI TAFUA QMHA

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1689948457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAIAH LAFI TAFUA QMHA

Provider Business Mailing Address
First Line	:	2920 N GREEN VALLEY PKWY
Second Line	:	BLDG #6, SUITE 642
City	:	HENDERSON
State	:	NV
Zip	:	89014-0406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 N GREEN VALLEY PKWY
Second Line	:	BLDG #6, SUITE 642
City	:	HENDERSON
State	:	NV
Zip	:	89014-0406
Country	:	US
Telephone Number	:	702-489-9946
Fax Number	:

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

Provider Enumeration Date	:	02/26/2012
Last Update Date	:	02/26/2012

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