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General NPI Number Information
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NPI Number | 1104738368
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Entity Type | Organization
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Legal Business Name | UNLV MEDICINE
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Dates
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Enumeration Date | 09/21/2026
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Last Update Date | 09/21/2026
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Provider Practice Location Address
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Address Line | 4000 E CHARLESTON BLVD STE 130
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City | LAS VEGAS
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State | NV
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Zip | 89104-6681
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Country | US
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Telephone | 702-968-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 E CHARLESTON BLVD STE 130
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City | LAS VEGAS
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State | NV
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Zip | 89104-6681
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Country | US
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Telephone | 702-968-4000
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | DANA GIBSON
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Credential |
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Telephone | 818-451-9016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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