Most Relevant Information
Provider Data
| NPI Number: | 1003195488 |
| Provider Name: | JERRELL DE'ANDRE ROBERTS |
| Entity Type: | Individual |
| Taxonomy Code: | 225400000X |
| Specialty: | Rehabilitation Practitioner |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/16/2011 |
| Last Updated: | 09/16/2011 |
Provider Practice Location
2704 PROSPECTOR MINE AVE
NORTH LAS VEGAS
NV
890311188
Practice Location Phone/Fax
| Phone: | 7026475300 |
| Fax: |
Provider Mailing Location
2704 PROSPECTOR MINE AVE
NORTH LAS VEGAS
NV
890311188
Provider Mailing Phone/Fax
| Phone: | 7026475300 |
| Fax: |