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Individual

MR. PAUL LAWRENCE A DEFIESTA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MSW, LCSWA, LMSW

Contact information

Practice address
4700 LAS VEGAS BLVD N, NELLIS AFB, NV 89191-6600
(702) 653-2273
Mailing address
4700 LAS VEGAS BLVD N, NELLIS AFB, NV 89191-6600
(702) 653-2273

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10499-M
NV
1041C0700X
Clinical Social Worker
P014490
NC

Other

Enumeration date
05/08/2020
Last updated
04/18/2024
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