Healthcare Provider Details

I. General information

NPI: 1437534534
Provider Name (Legal Business Name): SANTA FE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 E LAKE MEAD BLVD
NORTH LAS VEGAS NV
89030-6550
US

IV. Provider business mailing address

2828 E LAKE MEAD BLVD
NORTH LAS VEGAS NV
89030-6550
US

V. Phone/Fax

Practice location:
  • Phone: 702-218-1142
  • Fax: 702-224-2104
Mailing address:
  • Phone: 702-218-1142
  • Fax: 702-224-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number12464
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number12464
License Number StateNV

VIII. Authorized Official

Name: DR. MIGUEL ANGEL VARGAS
Title or Position: MEDICAL DIRECTOR
Credential: M.D., P.C.
Phone: 702-218-1142