MEDICARE: POINT PLACE WELLNESS GROUP

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1386316305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POINT PLACE WELLNESS GROUP

Provider Business Mailing Address
First Line	:	9856 POPLAR POINT AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-6315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9856 POPLAR POINT AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-6315
Country	:	US
Telephone Number	:	702-328-4634
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	AMBER SUAREZ
Credential	:
Telephone Number	:	702-328-4634

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	09/28/2021

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Directions to “POINT PLACE WELLNESS GROUP ” Practice Location

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