Healthcare Provider Details

I. General information

NPI: 1285876243
Provider Name (Legal Business Name): NEVADA YOUTH ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PMB125/7380 S. EASTERN AVE. STE. 124
LAS VEGAS NV
89123-1552
US

IV. Provider business mailing address

PMB125/7380 S. EASTERN AVE. STE. 124
LAS VEGAS NV
89123-1552
US

V. Phone/Fax

Practice location:
  • Phone: 702-656-4910
  • Fax: 702-656-4910
Mailing address:
  • Phone: 702-656-4910
  • Fax: 702-656-4910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID B. OSMAN
Title or Position: PRESIDENT
Credential:
Phone: 702-393-6163