Healthcare Provider Details

I. General information

NPI: 1033476023
Provider Name (Legal Business Name): EVENSEN AND TRIPPI MENS HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9499 W CHARLESTON BLVD SUITE 270
LAS VEGAS NV
89117-7150
US

IV. Provider business mailing address

9499 W CHARLESTON BLVD SUITE: 270
LAS VEGAS NV
89117-7150
US

V. Phone/Fax

Practice location:
  • Phone: 702-778-5900
  • Fax: 702-778-5901
Mailing address:
  • Phone: 702-778-5900
  • Fax: 702-778-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIK EVENSEN
Title or Position: MEMBER
Credential: DO
Phone: 702-778-5900