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General NPI Number Information
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NPI Number | 1134597370
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Entity Type | Organization
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Legal Business Name | ALTA WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 6655 W SAHARA AVE STE B200-138
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City | LAS VEGAS
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State | NV
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Zip | 89146-0842
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Country | US
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Telephone | 702-336-3460
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Fax |
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Provider Business Mailing Address
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Address Line | 1027 S RAINBOW BLVD # 270
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City | LAS VEGAS
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State | NV
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Zip | 89145-6232
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERTO SUAREZ
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Credential |
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Telephone | 702-336-3460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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