Provider Demographics
NPI:1861095960
Name:ANDASOL, JUAN ALEJANDRO (LMT)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ALEJANDRO
Last Name:ANDASOL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 ROARING LION AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0665
Mailing Address - Country:US
Mailing Address - Phone:702-326-5894
Mailing Address - Fax:
Practice Address - Street 1:2506 ROARING LION AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0665
Practice Address - Country:US
Practice Address - Phone:702-326-5894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.10467225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist