Healthcare Provider Details

I. General information

NPI: 1750568754
Provider Name (Legal Business Name): LAS VEGAS FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 S CASINO CENTER BLVD
LAS VEGAS NV
89104-1105
US

IV. Provider business mailing address

1311 S CASINO CENTER BLVD
LAS VEGAS NV
89104-1105
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-6262
  • Fax: 702-382-5017
Mailing address:
  • Phone: 702-382-6262
  • Fax: 702-382-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number10116
License Number StateNV

VIII. Authorized Official

Name: SUSAN BENASSI
Title or Position: DIRECTOR
Credential:
Phone: 702-382-6262