Healthcare Provider Details

I. General information

NPI: 1437415304
Provider Name (Legal Business Name): NEVADA STATE FAMILY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 S. JONES BLVD STE. 1
LAS VEGAS NV
89103
US

IV. Provider business mailing address

3815 S. JONES BLVD STE. 1
LAS VEGAS NV
89103
US

V. Phone/Fax

Practice location:
  • Phone: 702-431-3122
  • Fax: 702-558-2090
Mailing address:
  • Phone: 702-431-3122
  • Fax: 702-558-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN000962
License Number StateNV

VIII. Authorized Official

Name: ALAN JAUREGUI
Title or Position: MANAGING MEMBER
Credential: NURSE PRACTIONER
Phone: 702-266-7277