MEDICARE: LSDCCN OF NEVADA LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QI0500X	Infusion Therapy Clinic/Center
2	251F00000X	Home Infusion Agency
3	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1346514502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LSDCCN OF NEVADA LLC

Provider Business Mailing Address
First Line	:	9324 SIENNA RIDGE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7013
Country	:	US
Telephone Number	:	702-203-1715
Fax Number	:

Provider Business Practice Location Address
First Line	:	9324 SIENNA RIDGE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7013
Country	:	US
Telephone Number	:	702-203-1715
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ZAFRIR DIAMANT
Credential	:
Telephone Number	:	702-203-1715

Provider Enumeration Date	:	03/05/2012
Last Update Date	:	05/03/2017

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