Individual
DR. LASCHAVIO FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDD
Contact information
Practice address
770 W LONE MOUNTAIN RD, 2077, NORTH LAS VEGAS, NV 89031-3008
(702) 540-0344
(702) 331-0785
Mailing address
770 W LONE MOUNTAIN RD, 2077, NORTH LAS VEGAS, NV 89031-3008
(702) 540-0344
(702) 331-0785
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
07/12/2011
Last updated
07/12/2011
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