NPI 1104516095 · live from the CMS NPI Registry
Samantha Nichol Defalco
Dietitian, Registered in Las Vegas, NV. National Provider Identifier 1104516095, active.
NPI record
| NPI | 1104516095 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 9300 W Sunset Rd, Las Vegas, NV 89148 |
| Practice phone | 702-351-1601 |
| Enumerated | May 12, 2023 |
| Last updated | June 5, 2024 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 40903-DI-0 (NV) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.