Healthcare Provider Details

I. General information

NPI: 1104589266
Provider Name (Legal Business Name): FJW INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 S MARYLAND PKWY STE 230
LAS VEGAS NV
89109-1548
US

IV. Provider business mailing address

2870 S MARYLAND PKWY STE 230
LAS VEGAS NV
89109-1548
US

V. Phone/Fax

Practice location:
  • Phone: 702-330-0530
  • Fax: 702-476-9930
Mailing address:
  • Phone: 702-330-0530
  • Fax: 702-476-9930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RITA KUHL
Title or Position: DIRECTOR
Credential:
Phone: 702-762-2592