Healthcare Provider Details

I. General information

NPI: 1164095899
Provider Name (Legal Business Name): ADULT HEALTH AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 BUSINESS PARK CT STE 100
LAS VEGAS NV
89128-9019
US

IV. Provider business mailing address

2881 BUSINESS PARK CT STE 100
LAS VEGAS NV
89128-9019
US

V. Phone/Fax

Practice location:
  • Phone: 702-510-4508
  • Fax: 702-724-0522
Mailing address:
  • Phone: 702-510-4508
  • Fax: 702-724-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HUMBERTO RODRIGUEZ
Title or Position: COO
Credential:
Phone: 702-510-4508