Deangelo Henderson

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

MP00479 Issued in NV

Legal business name

DEANGELO HENDERSON

Practice address

3380 E Russell Rd #104
Las Vegas, NV 89120-3402

Phone

(702) 487-6221

Fax

(702) 487-6623

NPI assigned

Nov 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Deangelo D Henderson

Title

Owner

Phone

(702) 487-6221

Specialties & licenses 1

Addresses

Other names 1

• Golden Heart Medical Supplies Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216252800000",
    "number": "1396925129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3380 E RUSSELL RD #104",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891203402",
            "telephone_number": "702-487-6221",
            "fax_number": "702-487-6623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3380 E RUSSELL RD #104",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891203402",
            "telephone_number": "702-487-6221",
            "fax_number": "702-487-6623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEANGELO HENDERSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2008-07-17",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "DEANGELO",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-487-6221"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NV",
            "license": "MP00479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Golden Heart Medical Supplies",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mercy Deanda
• Ledontay Deandrade
• G. A Deandrea, MD
• Justin Deandrea, MD
• Samuel Deangelis
• Debra Denise Dear
• Conner Dearden, DO
• Brynne Cara Campbell Dearie
• Eloise Deary
• Patricia Deary

• Durable Medical Equipment & Medical Supplies in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Durable Medical Equipment & Medical Supplies in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.