Healthcare Provider Details

I. General information

NPI: 1376301192
Provider Name (Legal Business Name): FAMILY CLINIC OF NEVADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 W HORIZON RIDGE PKWY STE 110
HENDERSON NV
89012-3508
US

IV. Provider business mailing address

2688 ORNATE REGIMENT ST
HENDERSON NV
89044-1625
US

V. Phone/Fax

Practice location:
  • Phone: 760-900-2169
  • Fax:
Mailing address:
  • Phone: 760-900-2169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN NEFF
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 760-900-2169