Healthcare Provider Details

I. General information

NPI: 1659322907
Provider Name (Legal Business Name): MR. JOSEPH M. HERBST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E CHARLESTON BLVD
LAS VEGAS NV
89104-6659
US

IV. Provider business mailing address

2069 N WALNUT RD
LAS VEGAS NV
89115-5347
US

V. Phone/Fax

Practice location:
  • Phone: 702-452-2490
  • Fax:
Mailing address:
  • Phone: 702-452-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: