Healthcare Provider Details

I. General information

NPI: 1295463123
Provider Name (Legal Business Name): HELIOS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8425 W FLAMINGO RD STE 2
LAS VEGAS NV
89147-4160
US

IV. Provider business mailing address

8425 W FLAMINGO RD STE 2
LAS VEGAS NV
89147-4160
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-9882
  • Fax: 702-995-0242
Mailing address:
  • Phone: 702-912-9882
  • Fax: 702-995-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ISADORIS OTANO GUTIERREZ
Title or Position: MANAGING MEMBER
Credential:
Phone: 702-912-9886