Individual
AMAYA FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2124 TRAVIS ST, NORTH LAS VEGAS, NV 89030-4012
(702) 612-1823
Mailing address
2124 TRAVIS ST, NORTH LAS VEGAS, NV 89030-4012
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
03/07/2012
Last updated
03/07/2012
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