Healthcare Provider Details

I. General information

NPI: 1598892432
Provider Name (Legal Business Name): SKIN CHECK SUMMERLIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9416 DEL WEBB BLVD
LAS VEGAS NV
89134-8314
US

IV. Provider business mailing address

6425 WESTWIND RD
LAS VEGAS NV
89118-3442
US

V. Phone/Fax

Practice location:
  • Phone: 702-234-2311
  • Fax: 702-579-3909
Mailing address:
  • Phone: 702-234-2311
  • Fax: 702-579-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS ROUSSEL
Title or Position: BILLING DEPARTMENT
Credential:
Phone: 702-234-2311