Provider Demographics
NPI:1336459023
Name:LARIOS, DANIELLE NICOLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICOLE
Last Name:LARIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 MONTESSOURI ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3061
Mailing Address - Country:US
Mailing Address - Phone:702-478-8400
Mailing Address - Fax:702-478-8500
Practice Address - Street 1:2560 MONTESSOURI ST
Practice Address - Street 2:SUITE 207
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3061
Practice Address - Country:US
Practice Address - Phone:702-478-8400
Practice Address - Fax:702-478-8500
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV82OtherAMERIGROUP
NV82Medicaid