Healthcare Provider Details

I. General information

NPI: 1962089268
Provider Name (Legal Business Name): ALIJAH P HINSON CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 S CHIEFTAIN ST
LAS VEGAS NV
89178-6301
US

IV. Provider business mailing address

9225 S CHIEFTAIN ST
LAS VEGAS NV
89178-6301
US

V. Phone/Fax

Practice location:
  • Phone: 702-337-3647
  • Fax:
Mailing address:
  • Phone: 860-268-8951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: