MEDICARE: WEALTHY CKKK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1023796935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEALTHY CKKK

Provider Business Mailing Address
First Line	:	2979 SALTILLO LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-2524
Country	:	US
Telephone Number	:	702-913-5970
Fax Number	:

Provider Business Practice Location Address
First Line	:	2979 SALTILLO LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-2524
Country	:	US
Telephone Number	:	702-913-5970
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLARIS MUNESU NDORO
Credential	:	MD
Telephone Number	:	702-913-5970

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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Directions to “WEALTHY CKKK ” Practice Location

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