Provider Demographics
NPI:1922714021
Name:SAMPAGA, RHOEL JEROME RONE
Entity Type:Individual
Prefix:
First Name:RHOEL JEROME
Middle Name:RONE
Last Name:SAMPAGA
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 1:5477 CACTUS THORN AVE APT C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-6015
Mailing Address - Country:US
Mailing Address - Phone:702-820-8852
Mailing Address - Fax:
Practice Address - Street 1:5477 CACTUS THORN AVE APT C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-6015
Practice Address - Country:US
Practice Address - Phone:702-820-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOTA-3148224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty