Healthcare Provider Details

I. General information

NPI: 1811770373
Provider Name (Legal Business Name): XTENDNILLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 N RANCHO SUITE 108
LAS VEGAS NV
89130
US

IV. Provider business mailing address

304 S JONES BLVD # 284
LAS VEGAS NV
89107-2623
US

V. Phone/Fax

Practice location:
  • Phone: 702-841-1897
  • Fax:
Mailing address:
  • Phone: 702-841-1897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINA R THOMPSON
Title or Position: MANAGER
Credential:
Phone: 702-841-1897