Provider Demographics
NPI:1174178339
Name:DERASIN, ALBERT
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:DERASIN
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 1:600 E BONANZA RD STE 244
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3039
Mailing Address - Country:US
Mailing Address - Phone:702-556-4199
Mailing Address - Fax:
Practice Address - Street 1:600 E BONANZA RD STE 244
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3039
Practice Address - Country:US
Practice Address - Phone:702-556-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant