Healthcare Provider Details

I. General information

NPI: 1174369623
Provider Name (Legal Business Name): ELITE INFECTIOUS DISEASE OF NEVADA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 N RAINBOW BLVD STE 110-A
LAS VEGAS NV
89108-5011
US

IV. Provider business mailing address

6765 W CHARLESTON BLVD STE 170
LAS VEGAS NV
89146-2001
US

V. Phone/Fax

Practice location:
  • Phone: 725-253-4055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LEA DIOLA
Title or Position: PRACTICE OWNER
Credential: APRN
Phone: 725-253-4055