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General NPI Number Information
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NPI Number | 1083919328
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED COALITION LLC
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 2340 PASEO DEL PRADO BUILDING D SUITE 206
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City | LAS VEGAS
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State | NV
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Zip | 89102-4360
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Country | US
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Telephone | 702-485-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 2340 PASEO DEL PRADO BUILDING D SUITE 206
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City | LAS VEGAS
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State | NV
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Zip | 89102-4360
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Country | US
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Telephone | 702-485-2121
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | MS. MYRNA T PILI
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Credential | MBA
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Telephone | 702-569-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | NV
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