Healthcare Provider Details

I. General information

NPI: 1275497471
Provider Name (Legal Business Name): SOLACE MEDICAL CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 E FLAMINGO RD STE 202
LAS VEGAS NV
89121-5064
US

IV. Provider business mailing address

3430 E FLAMINGO RD STE 202
LAS VEGAS NV
89121-5064
US

V. Phone/Fax

Practice location:
  • Phone: 702-319-4291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: LIU CHIONG RIVERO
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-319-4291