Alan Detiberiis, A.PATH, DNP

Primary specialty

Clinical Informatics (Pathology) PhysicianTaxonomy code 207ZC0008X

License

405787 Issued in NV

Practice address

1205 W Warm Springs Rd Ste 100
Henderson, NV 89014-8741

Phone

(702) 265-3033

NPI assigned

Jul 28, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1501200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1679097976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 SEMINOLE LN",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890155565",
            "telephone_number": "702-265-3033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 W WARM SPRINGS RD STE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890148741",
            "telephone_number": "702-265-3033"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1208 Seminole Ln",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890155565",
            "country_code": "US",
            "telephone_number": "702-265-3033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DETIBERIIS",
        "first_name": "ALAN",
        "credential": "A.PATH, DNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-28",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "ZZ",
            "license": "D-16-1125-1121-A",
            "primary": false
        },
        {
            "code": "374K00000X",
            "taxonomy_group": "",
            "desc": "Religious Nonmedical Practitioner",
            "state": "NV",
            "license": "NA",
            "primary": false
        },
        {
            "code": "207ZC0008X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Informatics",
            "state": "NV",
            "license": "405787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Informatics (Pathology) Physician in Henderson, NV
• Providers in Henderson, NV by specialty
• Clinical Informatics (Pathology) Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; 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.