Organization
DOMINIQUE CROCKER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE LAKHIL CROCKER (MENTOR)
(702) 955-7708
Entity
Organization
Contact information
Practice address
917 WILLOW TREE DR #A, LAS VEGAS, NV 89128
(702) 955-7708
Mailing address
917 WILLOW TREE DR UNIT A, LAS VEGAS, NV 89128-3321
(702) 955-7708
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
NV
Other
Enumeration date
09/14/2016
Last updated
09/14/2016
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