Healthcare Provider Details

I. General information

NPI: 1588703698
Provider Name (Legal Business Name): DR MIRIAM & SHELDON G ADELSON CLINIC OF DRUG ABUSE TREATMENT & RESEARC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 S MARYLAND PKWY SUITE 64
LAS VEGAS NV
89169
US

IV. Provider business mailing address

3661 S MARYLAND PKWY SUITE 64
LAS VEGAS NV
89169
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-0081
  • Fax:
Mailing address:
  • Phone: 702-735-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number2583NTC8
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberRA0254209
License Number StateNV

VIII. Authorized Official

Name: MRS. SHIRLEY LINZY
Title or Position: CLINIC DIRECTOR
Credential: RN MS
Phone: 702-735-7900