Individual
JOHNATHAN RYAN TAITANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2208 S NELLIS BLVD STE 5, LAS VEGAS, NV 89104-6211
(702) 798-7770
(702) 895-7776
Mailing address
2610 S JONES BLVD STE 1, LAS VEGAS, NV 89146-5635
(702) 723-8314
(702) 895-7776
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
SL0955
NV
207R00000X
Internal Medicine Physician
Primary
DO2144
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184062309
—
NV
01
—
DO2144
STATE LICENSE
NV
Enumeration date
06/10/2013
Last updated
10/13/2025
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