Provider Demographics
NPI:1851663066
Name:ADAMS, DARRELL DEMETRIS I (MA)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:DEMETRIS
Last Name:ADAMS
Suffix:I
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 MCKNIGHT ST
Mailing Address - Street 2:APT. C - 223
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-8711
Mailing Address - Country:US
Mailing Address - Phone:702-764-7034
Mailing Address - Fax:
Practice Address - Street 1:640 MCKNIGHT ST
Practice Address - Street 2:APT. C - 223
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-8711
Practice Address - Country:US
Practice Address - Phone:702-764-7034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner