Healthcare Provider Details

I. General information

NPI: 1174503429
Provider Name (Legal Business Name): COMPREHENSIVE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 E LAKE MEAD PKWY # 301
HENDERSON NV
89015
US

IV. Provider business mailing address

110 N BOULDER HWY # 120-08
HENDERSON NV
89015
US

V. Phone/Fax

Practice location:
  • Phone: 702-577-0543
  • Fax: 515-583-4374
Mailing address:
  • Phone: 702-577-0543
  • Fax: 515-583-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0926
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0926
License Number StateNV

VIII. Authorized Official

Name: DAVID RIVAS
Title or Position: CMO
Credential: DO
Phone: 702-526-5078