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Individual

DUSTIN DOUGLAS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
50 N 21 ST #139, LAS VEGAS, NV 89101
(702) 955-0912
Mailing address
50 N 21ST ST APT 139, LAS VEGAS, NV 89101-5076
(702) 955-0912

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
224ZR0403X
Driving and Community Mobility Occupational Therapy Assistant

Other

Enumeration date
06/08/2017
Last updated
07/21/2022
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