Provider Demographics
NPI:1174821433
Name:MESAROS, OLIMPIU ADRIAN
Entity Type:Individual
Prefix:
First Name:OLIMPIU
Middle Name:ADRIAN
Last Name:MESAROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 SPRUCE OAK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0179
Mailing Address - Country:US
Mailing Address - Phone:702-328-1454
Mailing Address - Fax:
Practice Address - Street 1:4630 SPRUCE OAK DR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0179
Practice Address - Country:US
Practice Address - Phone:702-328-1454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner