Healthcare Provider Details

I. General information

NPI: 1477150720
Provider Name (Legal Business Name): SILVER SUMMIT SOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 LINDELL RD STE D
LAS VEGAS NV
89103-1200
US

IV. Provider business mailing address

3651 LINDELL RD STE D
LAS VEGAS NV
89103-1200
US

V. Phone/Fax

Practice location:
  • Phone: 562-314-9676
  • Fax:
Mailing address:
  • Phone: 562-314-9676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCO ANTONIO RAMIREZ
Title or Position: OWNER
Credential:
Phone: 562-314-9676