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NPI Code Detail

MEDICARE: RONALD REAVES

MEDICARE:   RONALD  REAVES
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1912282161
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD REAVES
Provider Business Mailing Address
First Line : 5150 S PECOS RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-1237
Country : US
Telephone Number : 702-483-5919
Fax Number : 702-483-5546
Provider Business Practice Location Address
First Line : 5201 S. TORREY PINES DRIVE
Second Line : #1276
City : LAS VEGAS
State : NV
Zip : 89118
Country : US
Telephone Number : 702-619-9053
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2011
Last Update Date : 11/14/2011

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Directions to “ RONALD REAVES ” Practice Location

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