Healthcare Provider Details

I. General information

NPI: 1942657473
Provider Name (Legal Business Name): LIVING LIFE MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 W SAHARA AVE STE 111
LAS VEGAS NV
89117-2799
US

IV. Provider business mailing address

7720 W SAHARA AVE STE 111
LAS VEGAS NV
89117-2799
US

V. Phone/Fax

Practice location:
  • Phone: 702-254-9014
  • Fax: 702-254-9016
Mailing address:
  • Phone: 702-254-9014
  • Fax: 702-254-9016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNV

VIII. Authorized Official

Name: LESLIE DAWN ROWENS
Title or Position: OWNER
Credential: P.A.
Phone: 702-449-4889