Healthcare Provider Details

I. General information

NPI: 1033387196
Provider Name (Legal Business Name): R & C ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 LORENZI ST
LAS VEGAS NV
89107-2469
US

IV. Provider business mailing address

321 LORENZI ST
LAS VEGAS NV
89107-2469
US

V. Phone/Fax

Practice location:
  • Phone: 702-445-4943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number212896
License Number StateNV

VIII. Authorized Official

Name: CASSANDRA M HILDRETH
Title or Position: PARTNER
Credential:
Phone: 702-445-4943