Healthcare Provider Details

I. General information

NPI: 1063127801
Provider Name (Legal Business Name): ALPHA & OMEGA TOTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W OAKEY BLVD STE B7
LAS VEGAS NV
89146-3395
US

IV. Provider business mailing address

5000 W OAKEY BLVD STE B7
LAS VEGAS NV
89146-3395
US

V. Phone/Fax

Practice location:
  • Phone: 702-831-3869
  • Fax:
Mailing address:
  • Phone: 702-831-3869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: GABRIELA DE LUNA OLIVARES
Title or Position: CEO
Credential:
Phone: 702-831-3869