Healthcare Provider Details

I. General information

NPI: 1063978187
Provider Name (Legal Business Name): ANTHONY QUINN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 SAINT ROSE PKWY STE 227
HENDERSON NV
89052-4840
US

IV. Provider business mailing address

8550 W CHARLESTON BLVD STE 102-403
LAS VEGAS NV
89117-9210
US

V. Phone/Fax

Practice location:
  • Phone: 702-685-3300
  • Fax: 702-586-3333
Mailing address:
  • Phone: 702-685-3300
  • Fax: 702-586-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANTHONY QUINN
Title or Position: OWNER
Credential: MD
Phone: 702-685-3300