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General NPI Number Information
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NPI Number | 1154134997
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Entity Type | Organization
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Legal Business Name | EFFECTIVE THERAPY AND MEDICAL LLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 8275 S EASTERN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89123-2591
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Country | US
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Telephone | 435-229-3245
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Fax |
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Provider Business Mailing Address
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Address Line | 8275 S EASTERN AVE STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89123-2545
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Country | US
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Telephone | 435-229-3245
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GUSTAVO MEDINA
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Credential |
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Telephone | 435-229-3245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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