Healthcare Provider Details

I. General information

NPI: 1063694651
Provider Name (Legal Business Name): FERTILITY CENTER OF LAS VEGAS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 W SAHARA AVE STE 100
LAS VEGAS NV
89117-5890
US

IV. Provider business mailing address

8851 W SAHARA AVE STE 100
LAS VEGAS NV
89117-5890
US

V. Phone/Fax

Practice location:
  • Phone: 702-254-1777
  • Fax: 702-228-2678
Mailing address:
  • Phone: 702-254-1777
  • Fax: 702-228-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRUCE S SHAPIRO
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 702-254-1777