Healthcare Provider Details

I. General information

NPI: 1639841737
Provider Name (Legal Business Name): ALISA SWEENEY MEDICAL TECHICHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 E DESERT INN RD STE 240
LAS VEGAS NV
89121-3610
US

IV. Provider business mailing address

7053 SOLANA RIDGE DR
NORTH LAS VEGAS NV
89084-2536
US

V. Phone/Fax

Practice location:
  • Phone: 725-204-7528
  • Fax:
Mailing address:
  • Phone: 714-815-5944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: