Healthcare Provider Details

I. General information

NPI: 1851901722
Provider Name (Legal Business Name): THE NEVADA WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9691 TRAILWOOD DR STE 104
LAS VEGAS NV
89134-6254
US

IV. Provider business mailing address

221 POPOLO DR
LAS VEGAS NV
89138-1508
US

V. Phone/Fax

Practice location:
  • Phone: 702-518-7180
  • Fax:
Mailing address:
  • Phone: 718-431-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: CHUCK GOMEZ
Title or Position: OWNER
Credential:
Phone: 646-241-7728