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General NPI Number Information
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NPI Number | 1023321718
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Entity Type | Organization
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Legal Business Name | TAHOE AESTHETIC AND INTEGRATIVE MEDICINE, LLC
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 770 NORTHWOOD BLVD
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City | INCLINE VILLAGE
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State | NV
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Zip | 89451-8284
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Country | US
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Telephone | 775-298-1750
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Fax |
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Provider Business Mailing Address
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Address Line | 679 SADDLEHORN DR
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City | INCLINE VILLAGE
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State | NV
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Zip | 89451-8500
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Country | US
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Telephone | 775-298-1750
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | REBECCA GELBER
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Credential | MD
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Telephone | 775-298-1750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 10275
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License Number State | NV
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