Healthcare Provider Details

I. General information

NPI: 1518549567
Provider Name (Legal Business Name): KEIFFER HEPOLA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N RAINBOW BLVD STE 203
LAS VEGAS NV
89107-1084
US

IV. Provider business mailing address

500 N RAINBOW BLVD STE 203
LAS VEGAS NV
89107-1084
US

V. Phone/Fax

Practice location:
  • Phone: 702-259-1228
  • Fax:
Mailing address:
  • Phone: 702-259-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO3903
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: