MEDICARE: SPECTRA HEALTH PROFESSIONAL LLC

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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1720750243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRA HEALTH PROFESSIONAL LLC

Provider Business Mailing Address
First Line	:	1000 N. GREEN VALLEY PARKWAY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-6170
Country	:	US
Telephone Number	:	702-906-0027
Fax Number	:

Provider Business Practice Location Address
First Line	:	7900 W. SAHARA AVENUE
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7921
Country	:	US
Telephone Number	:	702-906-0027
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	REBEKAH DEE TRUMAN
Credential	:
Telephone Number	:	702-906-0027

Provider Enumeration Date	:	10/03/2021
Last Update Date	:	10/03/2021

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