Jack Lavivong
Technician, Personal Care Attendant in Las Vegas, NV. Individual provider (NPI-1).
NPI number1669080693
StatusActive
Last updated in NPPESJul 15, 2020
Details
- NPI
- 1669080693
- Entity type
- Individual (NPI-1)
- Name
- Jack Lavivong
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 15, 2020
- Certification date
- Jul 15, 2020
- Last updated
- Jul 15, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3747P1801X | Technician, Personal Care Attendant | – | – | Yes |
Practice location
5858 S Pecos Rd # I-100Las Vegas, NV 89120-5401
Phone 702-855-3382
Mailing address
5858 S Pecos Rd # I-100Las Vegas, NV 89120-5401
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