Healthcare Provider Details

I. General information

NPI: 1346158433
Provider Name (Legal Business Name): ESSENTIAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W SUNSET RD STE 103
HENDERSON NV
89011-4112
US

IV. Provider business mailing address

600 W SUNSET RD STE 103
HENDERSON NV
89011-4112
US

V. Phone/Fax

Practice location:
  • Phone: 310-922-6071
  • Fax:
Mailing address:
  • Phone: 310-922-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: WALLY JOSEPH
Title or Position: OWNER & CEO
Credential: DNP, NP
Phone: 310-922-6071