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General NPI Number Information
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NPI Number | 1164095899
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Entity Type | Organization
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Legal Business Name | ADULT HEALTH AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 2881 BUSINESS PARK CT STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89128-9019
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Country | US
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Telephone | 702-510-4508
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Fax | 702-724-0522
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Provider Business Mailing Address
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Address Line | 2881 BUSINESS PARK CT STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89128-9019
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Country | US
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Telephone | 702-510-4508
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Fax | 702-724-0522
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Authorized Official
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Title or Position | COO
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Name | HUMBERTO RODRIGUEZ
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Credential |
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Telephone | 702-510-4508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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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 | 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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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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