MEDICARE: RICHARD DARYL ENRIQUEZ CHAPMAN

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	273Y00000X	Rehabilitation Hospital Unit	CNA030128	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000000	OTHER		N/A

General Provider Information

NPI Number	:	1750058335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD DARYL ENRIQUEZ CHAPMAN

Provider Business Mailing Address
First Line	:	4202 DIYA AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-4701
Country	:	US
Telephone Number	:	415-323-8247
Fax Number	:

Provider Business Practice Location Address
First Line	:	4202 DIYA AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-4701
Country	:	US
Telephone Number	:	415-323-8247
Fax Number	:

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

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	08/23/2021

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