Healthcare Provider Details

I. General information

NPI: 1336352574
Provider Name (Legal Business Name): AVALON & BEYOND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 DEL REY AVE
LAS VEGAS NV
89117-1409
US

IV. Provider business mailing address

7450 DEL REY AVE
LAS VEGAS NV
89117-1409
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-6102
  • Fax: 702-240-6104
Mailing address:
  • Phone: 702-240-6102
  • Fax: 702-240-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number1934AGZ-11
License Number StateNV

VIII. Authorized Official

Name: MISS LILIA SIOSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-240-6102