Healthcare Provider Details

I. General information

NPI: 1497432793
Provider Name (Legal Business Name): NEVADA ALWAYS YOUR DOCTOR LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 S EASTERN AVE STE 29
LAS VEGAS NV
89119-6100
US

IV. Provider business mailing address

4580 S EASTERN AVE STE 29
LAS VEGAS NV
89119-6100
US

V. Phone/Fax

Practice location:
  • Phone: 702-826-0956
  • Fax:
Mailing address:
  • Phone: 702-826-0956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESA SIMPORIOS MONTECILLO
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 702-826-0959