MEDICARE: ASMAYT DEBRETSION

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	372600000X	Adult Companion

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1605726926	OTHER	NV	NEVADA ID

General Provider Information

NPI Number	:	1790335883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASMAYT DEBRETSION

Provider Business Mailing Address
First Line	:	589 SIERRA VISTA DR APT 8
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3739
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4850 W FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3705
Country	:	US
Telephone Number	:	702-871-9917
Fax Number	:

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

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	09/19/2019

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Directions to “ ASMAYT DEBRETSION ” Practice Location

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