Healthcare Provider Details

I. General information

NPI: 1336940295
Provider Name (Legal Business Name): CFCFM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 N GREEN VALLEY PKWY STE 425A
HENDERSON NV
89014-0272
US

IV. Provider business mailing address

2551 N GREEN VALLEY PKWY STE 425A
HENDERSON NV
89014-0272
US

V. Phone/Fax

Practice location:
  • Phone: 702-747-7770
  • Fax: 704-444-7791
Mailing address:
  • Phone: 702-747-7770
  • Fax: 704-444-7791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA JESSICA TORO GONZALES
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-747-7770