Healthcare Provider Details

I. General information

NPI: 1669818787
Provider Name (Legal Business Name): SOUTHERN NEVADA VETERAN ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N CIMARRON RD
LAS VEGAS NV
89145-3902
US

IV. Provider business mailing address

121 N CIMARRON RD
LAS VEGAS NV
89145-3902
US

V. Phone/Fax

Practice location:
  • Phone: 702-400-7743
  • Fax:
Mailing address:
  • Phone: 702-400-7743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number19445
License Number StateNV

VIII. Authorized Official

Name: NADINE HARRIS
Title or Position: CREDENTIAL SPECIALIST
Credential:
Phone: 702-791-9000