Healthcare Provider Details

I. General information

NPI: 1215717483
Provider Name (Legal Business Name): REYNOLDS MD AND ASSOCIATES PERIOPERATIVE ANESTHESIA CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 N RANCHO DR STE 110
LAS VEGAS NV
89130-3151
US

IV. Provider business mailing address

6761 PEACH PIE AVE
LAS VEGAS NV
89131-3702
US

V. Phone/Fax

Practice location:
  • Phone: 702-917-3497
  • Fax:
Mailing address:
  • Phone: 702-917-3497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL REYNOLDS
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 702-917-3497