MEDICARE: BETHEL SINE M.D.

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	207R00000X	Internal Medicine Physician	11490	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285636662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHEL SINE M.D.

Provider Business Mailing Address
First Line	:	3001 LAKE EAST DR
Second Line	:	APT 2095
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2205
Country	:	US
Telephone Number	:	408-230-8915
Fax Number	:

Provider Business Practice Location Address
First Line	:	9505 HILLWOOD DR
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0506
Country	:	US
Telephone Number	:	702-304-2144
Fax Number	:	702-304-2147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	12/01/2021

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