Provider Demographics
NPI:1558671982
Name:LASORSA, DOMINICK CARL ANTHONY (MS, LADC)
Entity Type:Individual
Prefix:MR
First Name:DOMINICK CARL
Middle Name:ANTHONY
Last Name:LASORSA
Suffix:
Gender:M
Credentials:MS, LADC
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Mailing Address - Street 1:480 GALLETTI WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-5564
Mailing Address - Country:US
Mailing Address - Phone:775-688-2001
Mailing Address - Fax:775-688-2004
Practice Address - Street 1:480 GALLETTI WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5564
Practice Address - Country:US
Practice Address - Phone:775-688-2001
Practice Address - Fax:775-688-2004
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV7753484894OtherHOME PHONE