Healthcare Provider Details

I. General information

NPI: 1497986632
Provider Name (Legal Business Name): LORINDA CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 E PHILADELPHIA AVE
LAS VEGAS NV
89104-5331
US

IV. Provider business mailing address

4240 E PHILADELPHIA AVE
LAS VEGAS NV
89104-5331
US

V. Phone/Fax

Practice location:
  • Phone: 702-808-4335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNVMT119
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: