Individual
DE VON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9125 FISH TAIL AVE UNIT 103, LAS VEGAS, NV 89149-3168
(702) 955-1774
Mailing address
9125 FISH TAIL AVE UNIT 103, LAS VEGAS, NV 89149-3168
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
05/12/2022
Last updated
05/12/2022
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