Healthcare Provider Details

I. General information

NPI: 1043053390
Provider Name (Legal Business Name): SUMMIT INTEGRATED HEALTH OF NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CRIMSON CANYON DR STE 150
LAS VEGAS NV
89128-0848
US

IV. Provider business mailing address

2670 CRIMSON CANYON DR STE 150
LAS VEGAS NV
89128-0848
US

V. Phone/Fax

Practice location:
  • Phone: 702-232-3189
  • Fax: 702-726-9543
Mailing address:
  • Phone: 702-232-3189
  • Fax: 702-726-9543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERRYL CUADERNO TAKAHASHI
Title or Position: BILLING MANAGER
Credential:
Phone: 702-233-6196