Healthcare Provider Details

I. General information

NPI: 1619300993
Provider Name (Legal Business Name): MR. RALPH KEVIN SPENCER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 YANKEE CLIPPER DR
LAS VEGAS NV
89117-3510
US

IV. Provider business mailing address

3025 YANKEE CLIPPER DR
LAS VEGAS NV
89117-3510
US

V. Phone/Fax

Practice location:
  • Phone: 702-712-8558
  • Fax: 702-272-2303
Mailing address:
  • Phone: 702-712-8558
  • Fax: 702-272-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: