Provider Demographics
NPI:1740744671
Name:POWELL, ADRIAN GEORGE
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:GEORGE
Last Name:POWELL
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 1:8039 VILLA CANO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1655
Mailing Address - Country:US
Mailing Address - Phone:310-663-4154
Mailing Address - Fax:
Practice Address - Street 1:3301 SPRING MOUNTAIN RD STE 16
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8649
Practice Address - Country:US
Practice Address - Phone:310-663-4154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide