=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073438164
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOCORRO VERIDIAN MEDICAL CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2026
-----------------------------------------------------
Last Update Date | 08/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3430 E FLAMINGO RD STE 360G
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89121-5003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-779-3753
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3430 E FLAMINGO RD STE 360G
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89121-5003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LUIS ENRIQUE SOCORRO LOPEZ
-----------------------------------------------------
Credential | APRN-CNP
-----------------------------------------------------
Telephone | 702-510-9587
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------