Healthcare Provider Details

I. General information

NPI: 1801251608
Provider Name (Legal Business Name): NEVADA PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 PAINTED MIRAGE RD SUITE 217
LAS VEGAS NV
89149-4581
US

IV. Provider business mailing address

5550 PAINTED MIRAGE RD SUITE 217
LAS VEGAS NV
89149-4581
US

V. Phone/Fax

Practice location:
  • Phone: 702-410-9800
  • Fax: 702-924-1520
Mailing address:
  • Phone: 702-410-9800
  • Fax: 702-924-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MEAGAN HENDERSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-410-9800