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NPI Code Detail

MEDICARE: DAVID WONNACOTT

MEDICARE: DAVID WONNACOTT
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
1101Y00000XCounselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962884064
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID WONNACOTT
Provider Business Mailing Address
First Line : 3852 PALOS VERDES ST
Second Line : SUITE 40
City : LAS VEGAS
State : NV
Zip : 89119-6909
Country : US
Telephone Number : 702-485-1300
Fax Number :
Provider Business Practice Location Address
First Line : 3852 PALOS VERDES ST
Second Line : SUITE 40
City : LAS VEGAS
State : NV
Zip : 89119-6909
Country : US
Telephone Number : 702-485-1300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2015
Last Update Date : 06/24/2015

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Directions to “ DAVID WONNACOTT ” Practice Location

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