Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1871 | CA |
NPI | 1225570112 |
---|---|
Provider Name | Mr. Daniel David Vanta |
First Address | North Las Vegas, NV 89086-4400 |
Second Address | North Las Vegas, NV 89086-4400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2016 |
Last Update Date | 09/11/2016 |