Healthcare Provider Details

I. General information

NPI: 1033985650
Provider Name (Legal Business Name): HORMONEMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 08/04/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S 4TH ST STE 209
LAS VEGAS NV
89101-6845
US

IV. Provider business mailing address

930 S 4TH ST STE 209
LAS VEGAS NV
89101-6845
US

V. Phone/Fax

Practice location:
  • Phone: 929-282-4422
  • Fax: 929-282-4422
Mailing address:
  • Phone: 929-282-4422
  • Fax: 929-282-4422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW SESSA
Title or Position: AUTHORIZING REPRESENTATIVE
Credential:
Phone: 929-282-4422