Healthcare Provider Details

I. General information

NPI: 1073526448
Provider Name (Legal Business Name): LAS VEGAS HOUSE CALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9563 BORGATA BAY BLVD
LAS VEGAS NV
89147-8014
US

IV. Provider business mailing address

9563 BORGATA BAY BLVD
LAS VEGAS NV
89147-8014
US

V. Phone/Fax

Practice location:
  • Phone: 702-818-5933
  • Fax: 702-818-5934
Mailing address:
  • Phone: 702-818-5933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number7359
License Number StateNV

VIII. Authorized Official

Name: MONICA K MITCHELL
Title or Position: MANAGING MEMBER
Credential:
Phone: 702-818-5933