Provider Demographics
NPI:1164739280
Name:WESLEY, ANTONIO J (DME/TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:J
Last Name:WESLEY
Suffix:
Gender:M
Credentials:DME/TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 S RAINBOW BLVD UNIT 2015
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0631
Mailing Address - Country:US
Mailing Address - Phone:702-752-5256
Mailing Address - Fax:702-475-8576
Practice Address - Street 1:5250 S RAINBOW BLVD UNIT 2015
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0631
Practice Address - Country:US
Practice Address - Phone:702-752-5256
Practice Address - Fax:702-475-8576
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1009520911-001247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other