Healthcare Provider Details

I. General information

NPI: 1871749481
Provider Name (Legal Business Name): ANGELA S WEINSTOCK R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S RANCHO DR SUITE 12
LAS VEGAS NV
89106-4844
US

IV. Provider business mailing address

500 S RANCHO DR SUITE 12
LAS VEGAS NV
89106-4844
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-1887
  • Fax: 702-877-4536
Mailing address:
  • Phone: 702-877-1887
  • Fax: 702-877-4536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number894255
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: