Provider Demographics
NPI:1326451790
Name:SIRILLA, JEFFREY RYAN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RYAN
Last Name:SIRILLA
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 1:1101 BARTON GREEN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1682
Mailing Address - Country:US
Mailing Address - Phone:760-912-7082
Mailing Address - Fax:
Practice Address - Street 1:5175 CAMINO AL NORTE STE 100
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2408
Practice Address - Country:US
Practice Address - Phone:702-636-4870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner