Healthcare Provider Details

I. General information

NPI: 1659663813
Provider Name (Legal Business Name): ULTRA CARE LAS VEGAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10112 ROYAL MINT AVE
LAS VEGAS NV
89166-6539
US

IV. Provider business mailing address

10112 ROYAL MINT AVE
LAS VEGAS NV
89166-6539
US

V. Phone/Fax

Practice location:
  • Phone: 702-487-7055
  • Fax: 702-991-7258
Mailing address:
  • Phone: 702-487-7055
  • Fax: 702-991-7258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number076948
License Number StateNV

VIII. Authorized Official

Name: MS. IRENE HARRIS
Title or Position: PRESIDENT
Credential:
Phone: 702-487-7055