Healthcare Provider Details

I. General information

NPI: 1811703887
Provider Name (Legal Business Name): ADVANCED MEDICAL AND REHAB OF LV, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 W RUSSELL RD STE 380
LAS VEGAS NV
89148-1467
US

IV. Provider business mailing address

9205 W RUSSELL RD STE 380
LAS VEGAS NV
89148-1467
US

V. Phone/Fax

Practice location:
  • Phone: 310-413-6034
  • Fax:
Mailing address:
  • Phone: 310-413-6034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KARI ANN HAWKINS
Title or Position: OWNER
Credential:
Phone: 310-413-6034