Provider Demographics
NPI:1952795239
Name:ASIS, MARLO GRANT JR
Entity Type:Individual
Prefix:
First Name:MARLO
Middle Name:GRANT
Last Name:ASIS
Suffix:JR
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 1:2040 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE #302
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2227
Mailing Address - Country:US
Mailing Address - Phone:702-671-2273
Mailing Address - Fax:702-385-9399
Practice Address - Street 1:2040 W CHARLESTON BLVD
Practice Address - Street 2:SUITE #302
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2227
Practice Address - Country:US
Practice Address - Phone:702-671-2273
Practice Address - Fax:702-385-9399
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program