Healthcare Provider Details

I. General information

NPI: 1255174421
Provider Name (Legal Business Name): LEVON KUPCHYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 08/12/2024
Certification Date: 06/20/2024
Deactivation Date: 06/20/2024
Reactivation Date: 08/12/2024

III. Provider practice location address

3311 S RAINBOW BLVD STE 145
LAS VEGAS NV
89146-6208
US

IV. Provider business mailing address

3311 S RAINBOW BLVD STE 145
LAS VEGAS NV
89146-6208
US

V. Phone/Fax

Practice location:
  • Phone: 702-955-1261
  • Fax:
Mailing address:
  • Phone: 702-955-1261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: