Provider Demographics
NPI:1275958415
Name:DZAMESI, CORNELIUS
Entity Type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:
Last Name:DZAMESI
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 1:900 KAREN AVE STE B203
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1271
Mailing Address - Country:US
Mailing Address - Phone:702-893-2002
Mailing Address - Fax:702-369-3334
Practice Address - Street 1:900 KAREN AVE STE B203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1271
Practice Address - Country:US
Practice Address - Phone:702-893-2002
Practice Address - Fax:702-369-3334
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2000558-062-101251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health