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NPI Code Detail

MEDICARE: DRANREB ESPURA PT

MEDICARE: DRANREB ESPURA PT
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
1225100000XPhysical Therapist2021NV

General Provider Information

NPI Number : 1902294846
Entity Type Code : Individual
Provider Name (Legal Business Name) : DRANREB ESPURA PT
Provider Business Mailing Address
First Line : 3061 BELLA VERONA AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89141-3531
Country : US
Telephone Number : 702-883-1675
Fax Number :
Provider Business Practice Location Address
First Line : 2035 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2223
Country : US
Telephone Number : 702-386-7980
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2014
Last Update Date : 12/30/2014

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