1417594284 NPI number — DANIEL ALEXANDER LLC

Table of content: SABRINA GAY BLUMENBERG MD (NPI 1396505293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417594284 NPI number — DANIEL ALEXANDER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL ALEXANDER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417594284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 PEARBERRY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89183-7219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-897-0925
Provider Business Mailing Address Fax Number:
702-897-0926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 PEARBERRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89183-7219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-897-0925
Provider Business Practice Location Address Fax Number:
702-897-0926
Provider Enumeration Date:
11/29/2019

Additional Information

Authorized Official

Authorized Official Last Name:
DESAMITO
Authorized Official First Name:
ROY
Authorized Official Middle Name:
DEGUZMAN
Authorized Official Title or Position:
MEMBER / FACILITY MANAGER
Authorized Official Telephone Number:
702-897-0925

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9793-AGC . This is a "NV DEPT HEALTH & HUMAN SERVICES / DIV OF PUBLIC & BEHAVIORAL HEALTH" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com