Individual
JON G REQUENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8916 CRYSTAL CORAL WAY, LAS VEGAS, NV 89123-3141
(702) 782-8557
Mailing address
8916 CRYSTAL CORAL WAY, LAS VEGAS, NV 89123-3141
(702) 782-8557
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
10/15/2010
Last updated
10/15/2010
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