Active NPI
Daniel Dellwo, PA-C
- Medical Physician Assistant
- Las Vegas, NV
National Provider Identifier
1104224997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA-1192
- Practice address
- 901 Rancho LN Ste 135
Las Vegas, NV 89106-3826 - Phone
- (541) 250-1525
- NPI assigned
- Dec 11, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA-1192 | ID | Primary |
Addresses
Primary practice location
901 Rancho LN Ste 135
Las Vegas, NV 89106-3826
Mailing address
901 Rancho LN Ste 135
Las Vegas, NV 89106-3826
Phone (541) 250-1525
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-1192 | ID | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418256000000",
"number": "1104224997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 RANCHO LN STE 135",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891063826",
"telephone_number": "541-250-1525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 RANCHO LN STE 135",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891063826",
"telephone_number": "541-250-1525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELLWO",
"first_name": "DANIEL",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-12-11",
"last_updated": "2014-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "ID",
"license": "PA-1192",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.