Healthcare Provider Details

I. General information

NPI: 1942688932
Provider Name (Legal Business Name): DOCTORS CENTER AT RED ROCK CAPOBIANCO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N TENAYA WAY STE C
LAS VEGAS NV
89128-1400
US

IV. Provider business mailing address

2801 N TENAYA WAY STE C
LAS VEGAS NV
89128-1400
US

V. Phone/Fax

Practice location:
  • Phone: 702-684-7800
  • Fax: 702-684-7878
Mailing address:
  • Phone: 702-684-7800
  • Fax: 702-684-7878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number958
License Number StateNV

VIII. Authorized Official

Name: KELSI SKEE
Title or Position: CREDENTIALING
Credential:
Phone: 575-313-9251