Healthcare Provider Details

I. General information

NPI: 1285727602
Provider Name (Legal Business Name): VINCE LINK OMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 S. RAINBOW BLVD SUITE #140
LAS VEGAS NV
89146
US

IV. Provider business mailing address

2920 S. RAINBOW BLVD SUITE #140
LAS VEGAS NV
89146
US

V. Phone/Fax

Practice location:
  • Phone: 702-444-4775
  • Fax: 702-444-4776
Mailing address:
  • Phone: 702-444-4775
  • Fax: 702-444-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1017
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: