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General NPI Number Information
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NPI Number | 1134097058
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Entity Type | Organization
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Legal Business Name | REALCARE WELLNESS LLC
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Dates
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Enumeration Date | 10/24/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 732 S 6TH ST # 8014
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City | LAS VEGAS
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State | NV
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Zip | 89101-6948
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Country | US
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Telephone | 725-772-1939
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Fax | 702-442-4665
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Provider Business Mailing Address
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Address Line | 732 S 6TH ST # 8014
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City | LAS VEGAS
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State | NV
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Zip | 89101-6948
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Country | US
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Telephone | 725-772-1939
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Fax | 702-442-4665
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | MARK MAXILOM POLINTAN
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Credential | APRN, FNP-C
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Telephone | 725-772-1939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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