MEDICARE: SOARING EAGLES WELLNESS CENTER

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1821643461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOARING EAGLES WELLNESS CENTER

Provider Business Mailing Address
First Line	:	2971 JUNIPER HILLS BLVD UNIT 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-2973
Country	:	US
Telephone Number	:	714-365-9766
Fax Number	:

Provider Business Practice Location Address
First Line	:	2971 JUNIPER HILLS BLVD UNIT 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-2973
Country	:	US
Telephone Number	:	714-365-9766
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARQUEZ EAGLES
Credential	:
Telephone Number	:	714-365-9766

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	08/08/2019

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