Healthcare Provider Details

I. General information

NPI: 1831912013
Provider Name (Legal Business Name): AYURVEDA WELLNESS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 S DECATUR BLVD STE B6
LAS VEGAS NV
89103-6802
US

IV. Provider business mailing address

1027 S RAINBOW BLVD # 203
LAS VEGAS NV
89145-6232
US

V. Phone/Fax

Practice location:
  • Phone: 702-637-5198
  • Fax:
Mailing address:
  • Phone: 702-637-5198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ERICA L MARINO
Title or Position: OWNER
Credential:
Phone: 702-637-5198