NPI |
1548925811 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
1 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Provider Last Name Legal Name |
BROOKS |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
DEJAUN |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider Middle Name |
C |
The middle name of the provider, if the provider
is an individual. |
Provider First Line Business Practice Location Address |
4905 GOLDEN HAVEN AVE |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
LAS VEGAS |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address State Name |
NV |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
891303032 |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
9097805722 |
The country code in the location address of the provider being identified. |
Provider Enumeration Date |
11/2/2021 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
11/2/2021 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Gender Code |
M |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
3747P1801X |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
|
NPI Certification Date |
11/2/2021 |
|