MEDICARE: MENTE DALERE MD

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	2080N0001X	Neonatal-Perinatal Medicine Physician	4301045255	MI
2	2080N0001X	Neonatal-Perinatal Medicine Physician	13135	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2341592	OTHER	ECFMG
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4301045255	OTHER	CONTROLLED SUBSTANCE

General Provider Information

NPI Number	:	1710975420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MENTE DALERE MD

Provider Business Mailing Address
First Line	:	4513 SEA DREAM AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-3483
Country	:	US
Telephone Number	:	702-586-0830
Fax Number	:

Provider Business Practice Location Address
First Line	:	653 N TOWN CENTER DR STE 10
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0503
Country	:	US
Telephone Number	:	702-733-0981
Fax Number	:

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	03/07/2023

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Directions to “ MENTE DALERE MD” Practice Location

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