Healthcare Provider Details

I. General information

NPI: 1669923827
Provider Name (Legal Business Name): JORGENSON & KOKA LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 E POSTAL RD. SUITE 9
PAHRUMP NV
89048
US

IV. Provider business mailing address

9975 S EASTERN AVE SUITE 110
LAS VEGAS NV
89183-7949
US

V. Phone/Fax

Practice location:
  • Phone: 702-963-6363
  • Fax: 702-616-0657
Mailing address:
  • Phone: 702-963-6363
  • Fax: 702-616-0657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: QUENNIE GARCIA MANUEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-492-7208