Provider Demographics
NPI:1750868410
Name:LAMB, DARYL M
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:M
Last Name:LAMB
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 1:2920 S JONES BLVD STE 110B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5395
Mailing Address - Country:US
Mailing Address - Phone:702-321-5062
Mailing Address - Fax:702-960-7229
Practice Address - Street 1:2920 S JONES BLVD STE 110B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5395
Practice Address - Country:US
Practice Address - Phone:702-321-5062
Practice Address - Fax:702-960-7229
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator