Healthcare Provider Details

I. General information

NPI: 1114414885
Provider Name (Legal Business Name): KYLE WENTZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6930 S CIMARRON RD STE 260
LAS VEGAS NV
89113-2135
US

IV. Provider business mailing address

6930 S CIMARRON RD STE 260
LAS VEGAS NV
89113-2135
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-9700
  • Fax: 702-476-9138
Mailing address:
  • Phone: 702-476-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number009501
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: