Healthcare Provider Details

I. General information

NPI: 1487152823
Provider Name (Legal Business Name): PINNACLE PRIMARY CARE & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 S. EASTERN AVE.
LAS VEGAS NV
89119
US

IV. Provider business mailing address

4440 S. EASTERN AVE.
LAS VEGAS NV
89119
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-0023
  • Fax: 702-973-3477
Mailing address:
  • Phone: 702-476-0023
  • Fax: 702-973-3477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TENESHIA DACHELL SPENCER
Title or Position: CEO/OWNER
Credential:
Phone: 702-665-1690