Provider Demographics
NPI:1568465326
Name:WARNER, MITCHELL (CPO)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:
Last Name:WARNER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2578 BELCASTRO ST
Mailing Address - Street 2:STE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3067
Mailing Address - Country:US
Mailing Address - Phone:702-388-9909
Mailing Address - Fax:702-388-9929
Practice Address - Street 1:2578 BELCASTRO ST
Practice Address - Street 2:STE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3067
Practice Address - Country:US
Practice Address - Phone:702-388-9909
Practice Address - Fax:702-388-9929
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMP001021744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0377170001Medicare ID - Type UnspecifiedPROVIDER NUMBER