Healthcare Provider Details

I. General information

NPI: 1184116477
Provider Name (Legal Business Name): BRIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N RAINBOW BLVD STE 170
LAS VEGAS NV
89107-1189
US

IV. Provider business mailing address

800 N RAINBOW BLVD STE 170
LAS VEGAS NV
89107-1189
US

V. Phone/Fax

Practice location:
  • Phone: 702-205-9607
  • Fax:
Mailing address:
  • Phone: 702-205-9607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number StateNV

VIII. Authorized Official

Name: LOLITA ANNETTE HESTER
Title or Position: OWNER
Credential:
Phone: 702-205-9607