Healthcare Provider Details

I. General information

NPI: 1457281503
Provider Name (Legal Business Name): WELLNESS DIVERSITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3195 SAINT ROSE PKWY STE 212
HENDERSON NV
89052-3504
US

IV. Provider business mailing address

8255 LAS VEGAS BLVD S UNIT 309
LAS VEGAS NV
89123-1067
US

V. Phone/Fax

Practice location:
  • Phone: 702-301-2111
  • Fax:
Mailing address:
  • Phone: 702-301-2111
  • Fax: 855-898-8685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: HAYDEE DOCASAR
Title or Position: OWNER
Credential: MD
Phone: 702-301-2111