Healthcare Provider Details

I. General information

NPI: 1619126257
Provider Name (Legal Business Name): DIAGNOSTIC CENTER OF MEDICINE (ALLEN) LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 MOUNTAIN VISTA STREET SUITE 108
HENDERSON NV
89014
US

IV. Provider business mailing address

3012 S DURANGO DR SUITE 2
LAS VEGAS NV
89117-9186
US

V. Phone/Fax

Practice location:
  • Phone: 702-454-1322
  • Fax: 702-454-1624
Mailing address:
  • Phone: 702-366-1655
  • Fax: 702-942-4388

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE M. ALLEN
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 702-366-0640