Provider Demographics
NPI:1346759255
Name:GRIFFIN, DARON DELVON
Entity Type:Individual
Prefix:MR
First Name:DARON
Middle Name:DELVON
Last Name:GRIFFIN
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 1:5501 E HARMON AVE APT 159
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-5234
Mailing Address - Country:US
Mailing Address - Phone:435-720-6935
Mailing Address - Fax:
Practice Address - Street 1:1472 S HIGHWAY 373
Practice Address - Street 2:
Practice Address - City:AMARGOSA VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89020-1514
Practice Address - Country:US
Practice Address - Phone:775-372-1281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
NV225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No172V00000XOther Service ProvidersCommunity Health Worker