Provider Demographics
NPI:1013346329
Name:SAMPSON, RICKY D
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:D
Last Name:SAMPSON
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 1:2401 W BONANZA RD
Mailing Address - Street 2:STE L
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4774
Mailing Address - Country:US
Mailing Address - Phone:702-372-5519
Mailing Address - Fax:702-359-0041
Practice Address - Street 1:2401 W BONANZA RD
Practice Address - Street 2:STE L
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4774
Practice Address - Country:US
Practice Address - Phone:702-372-5519
Practice Address - Fax:702-359-0041
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner