Healthcare Provider Details

I. General information

NPI: 1346514502
Provider Name (Legal Business Name): LSDCCN OF NEVADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9324 SIENNA RIDGE DR
LAS VEGAS NV
89117-7013
US

IV. Provider business mailing address

9324 SIENNA RIDGE DR
LAS VEGAS NV
89117-7013
US

V. Phone/Fax

Practice location:
  • Phone: 702-203-1715
  • Fax:
Mailing address:
  • Phone: 702-203-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ZAFRIR DIAMANT
Title or Position: MEMBER
Credential:
Phone: 702-203-1715