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General NPI Number Information
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NPI Number | 1194373522
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Entity Type | Organization
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Legal Business Name | PRESTIGE ULTRASOUND, LLC
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 3945 W CHEYENNE AVE STE 203
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City | N LAS VEGAS
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State | NV
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Zip | 89032-8902
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Country | US
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Telephone | 702-423-0011
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Fax | 702-628-9996
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Provider Business Mailing Address
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Address Line | 3945 W CHEYENNE AVE STE 203
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City | N LAS VEGAS
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State | NV
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Zip | 89032-8902
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Country | US
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Telephone | 702-423-0011
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Fax | 702-628-9996
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Authorized Official
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Title or Position | CEO
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Name | MANUEL CARRANZA
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Credential |
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Telephone | 702-423-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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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 | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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