MEDICARE: ALISA SWEENEY MEDICAL TECHICHAN

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	156F00000X	Technician/Technologist		NV

General Provider Information

NPI Number	:	1639841737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA SWEENEY MEDICAL TECHICHAN

Provider Business Mailing Address
First Line	:	7053 SOLANA RIDGE DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2536
Country	:	US
Telephone Number	:	714-815-5944
Fax Number	:

Provider Business Practice Location Address
First Line	:	2755 E DESERT INN RD STE 240
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3610
Country	:	US
Telephone Number	:	725-204-7528
Fax Number	:

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

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

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Directions to “ ALISA SWEENEY MEDICAL TECHICHAN” Practice Location

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