Healthcare Provider Details

I. General information

NPI: 1679341317
Provider Name (Legal Business Name): EDDIE DEL VALLE MLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 E SAHARA AVE
LAS VEGAS NV
89104-3221
US

IV. Provider business mailing address

1018 E SAHARA AVE
LAS VEGAS NV
89104-3221
US

V. Phone/Fax

Practice location:
  • Phone: 702-780-4771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: