Healthcare Provider Details

I. General information

NPI: 1205102936
Provider Name (Legal Business Name): PUSH RESET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 DEAN MARTIN DR STE 230
LAS VEGAS NV
89103-4124
US

IV. Provider business mailing address

4315 DEAN MARTIN DR STE 230
LAS VEGAS NV
89103-4124
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-4871
  • Fax:
Mailing address:
  • Phone: 702-463-4871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERICA M ESKELI
Title or Position: MANAGING MBR
Credential:
Phone: 702-463-4871