Healthcare Provider Details

I. General information

NPI: 1013589142
Provider Name (Legal Business Name): OZOMOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 E CHARLESTON BLVD
LAS VEGAS NV
89104-1902
US

IV. Provider business mailing address

1721 E CHARLESTON BLVD
LAS VEGAS NV
89104-1902
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-9680
  • Fax:
Mailing address:
  • Phone: 702-515-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VALANDO STERLING
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 702-515-9680