Provider Demographics
NPI:1184931255
Name:DEVITO, ANTHONY ROSS
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ROSS
Last Name:DEVITO
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 1:4333 CHIRR LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4618
Mailing Address - Country:US
Mailing Address - Phone:702-416-0682
Mailing Address - Fax:
Practice Address - Street 1:3900 W CHARLESTON BLVD
Practice Address - Street 2:STE 170
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1628
Practice Address - Country:US
Practice Address - Phone:702-453-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker