MEDICARE: LAS VEGAS SPORTS AND SPINE 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	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1972265338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS SPORTS AND SPINE CENTER

Provider Business Mailing Address
First Line	:	PO BOX 25239
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-0239
Country	:	US
Telephone Number	:	702-707-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 S CIMARRON RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-2447
Country	:	US
Telephone Number	:	702-707-7246
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	REEKESH R PATEL
Credential	:	MD
Telephone Number	:	213-465-0994

Provider Enumeration Date	:	10/12/2021
Last Update Date	:	02/11/2022

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Directions to “LAS VEGAS SPORTS AND SPINE CENTER ” Practice Location

Language	Start Address	Practice Location

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