Justin Dellera

Key facts

NPI

1093069643

Entity type

Individual (NPI type 1)

Primary specialty

Rehabilitation Practitioner 225400000X

Practice address

100 Rosaschi Rd
Yerington, NV 89447-8722

Phone

(775) 392-2650

NPI assigned

Nov 5, 2012

Sex

Male

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rite of Passage Adolescent Treatment Centers and Schools, Inc. Psychiatric Residential Treatment Facility · Yerington, NV · NPI 1568549111
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 5, 2012.

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352073600000",
    "number": "1093069643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 BUSINESS PKWY STE B",
            "city": "MINDEN",
            "state": "NV",
            "postal_code": "894238961",
            "telephone_number": "775-392-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 ROSASCHI RD",
            "city": "YERINGTON",
            "state": "NV",
            "postal_code": "894478722",
            "telephone_number": "775-392-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELLERA",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-05",
        "last_updated": "2012-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Yerington, NV · Rehabilitation Practitioner in Nevada