Healthcare Provider Details

I. General information

NPI: 1225542046
Provider Name (Legal Business Name): FAMILY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 S VALLEY VIEW BLVD STE 103
LAS VEGAS NV
89102-8388
US

IV. Provider business mailing address

3110 S VALLEY VIEW BLVD STE 103
LAS VEGAS NV
89102-8388
US

V. Phone/Fax

Practice location:
  • Phone: 702-266-7277
  • Fax:
Mailing address:
  • Phone: 702-266-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNV

VIII. Authorized Official

Name: ALAN JAUREGUI
Title or Position: CEO
Credential: APRN
Phone: 702-266-7277