Healthcare Provider Details

I. General information

NPI: 1679336085
Provider Name (Legal Business Name): VINCENT COMELLO EMS ID: 6535-2457-40
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

IV. Provider business mailing address

4008 W COLTON AVE
NORTH LAS VEGAS NV
89032-8931
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-6675
  • Fax:
Mailing address:
  • Phone: 702-735-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number6535-2457-40
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: