Healthcare Provider Details

I. General information

NPI: 1942948625
Provider Name (Legal Business Name): DR. SIMON J. FARROW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 08/30/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5495 S RAINBOW BLVD STE 202
LAS VEGAS NV
89118-1873
US

IV. Provider business mailing address

1000 N GREEN VALLEY PKWY # 440-493
HENDERSON NV
89074-6163
US

V. Phone/Fax

Practice location:
  • Phone: 702-906-0027
  • Fax: 702-906-0160
Mailing address:
  • Phone: 702-906-0027
  • Fax: 702-906-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: REBEKAH TRUMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 702-906-0027