Healthcare Provider Details

I. General information

NPI: 1366127789
Provider Name (Legal Business Name): ENKI MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 ALGONQUIN DR
LAS VEGAS NV
89169-3150
US

IV. Provider business mailing address

4820 EL ESCORIAL DR
LAS VEGAS NV
89121-6805
US

V. Phone/Fax

Practice location:
  • Phone: 702-510-9587
  • Fax: 702-920-7677
Mailing address:
  • Phone: 702-510-9587
  • Fax: 702-920-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: YUSIMI LOPEZ RAMOS
Title or Position: OWNER
Credential:
Phone: 702-510-9587