Healthcare Provider Details

I. General information

NPI: 1588465736
Provider Name (Legal Business Name): BRIGHT PATH MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 BRIARCLIFF AVE
HENDERSON NV
89074-1210
US

IV. Provider business mailing address

2715 BRIARCLIFF AVE
HENDERSON NV
89074-1210
US

V. Phone/Fax

Practice location:
  • Phone: 702-412-9077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DORINE HAYNES
Title or Position: OWNER
Credential:
Phone: 702-412-9077