Healthcare Provider Details

I. General information

NPI: 1669926416
Provider Name (Legal Business Name): HALTHORE JOHNS PEDIATRIC NEUROLOGY ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 E DESERT INN RD
LAS VEGAS NV
89169-3211
US

IV. Provider business mailing address

2020 E DESERT INN RD
LAS VEGAS NV
89169-3211
US

V. Phone/Fax

Practice location:
  • Phone: 702-796-5505
  • Fax: 702-732-9830
Mailing address:
  • Phone: 702-796-5505
  • Fax: 702-732-9830

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: GRETA STEPHENS
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-796-5505