Healthcare Provider Details

I. General information

NPI: 1720750243
Provider Name (Legal Business Name): SPECTRA HEALTH PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2021
Last Update Date: 10/03/2021
Certification Date: 10/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 W. SAHARA AVENUE SUITE 100
LAS VEGAS NV
89117-7921
US

IV. Provider business mailing address

1000 N. GREEN VALLEY PARKWAY
HENDERSON NV
89074-6170
US

V. Phone/Fax

Practice location:
  • Phone: 702-906-0027
  • Fax:
Mailing address:
  • Phone: 702-906-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: REBEKAH DEE TRUMAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 702-906-0027