Individual
JOHNNY STALLION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5055 W HACIENDA AVE, APT. 2069, LAS VEGAS, NV 89118-0305
(757) 724-8679
Mailing address
5055 W HACIENDA AVE, APT. 2069, LAS VEGAS, NV 89118-0305
(757) 724-8679
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
04/26/2013
Last updated
04/26/2013
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