Healthcare Provider Details

I. General information

NPI: 1770772329
Provider Name (Legal Business Name): JOSE F TORREBLANCA DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 04/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 E CHARLESTON BLVD STE 3
LAS VEGAS NV
89104-1859
US

IV. Provider business mailing address

1611 E CHARLESTON BLVD STE 3
LAS VEGAS NV
89104-1859
US

V. Phone/Fax

Practice location:
  • Phone: 702-734-7566
  • Fax: 702-880-5777
Mailing address:
  • Phone: 702-734-7566
  • Fax: 702-880-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE F TORREBLANCA
Title or Position: PRESIDENT
Credential: DO
Phone: 702-734-7566