Blackson, Derick
Blackson, Derick is an sole proprietor health care provider with primary practice located at 3674 N Rancho Dr 101, Las Vegas NV 89130-3110. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Rehabilitation Practitioner, which is considered as his primary health care specialty. Blackson, Derick can be contacted via phone (702) 396-2988.Contact Information
Primary practice address
3674 N Rancho Dr 101
Las Vegas NV 89130-3110
Phone: (702) 396-2988
Fax: (510) 281-6883
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Rehabilitation Practitioner | 225400000X |
Profile Details
| NPI number | 1659785806 |
|---|---|
| LBN Legal business name | Blackson, Derick |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 16th, 2014 |
| Last updated | Jun 16th, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1659785806 | NPPES |
| Nevada | MEDICAID | 1114270832 |
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