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General NPI Number Information
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NPI Number | 1205553740
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Entity Type | Organization
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Legal Business Name | SWEET PEACE LLC
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Dates
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Enumeration Date | 10/25/2022
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 2109 WINDHURST ST
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City | N LAS VEGAS
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State | NV
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Zip | 89032-4826
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Country | US
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Telephone | 725-266-0616
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Fax |
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Provider Business Mailing Address
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Address Line | 2109 WINDHURST ST
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City | N LAS VEGAS
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State | NV
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Zip | 89032-4826
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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 | MANAGING MEMBER
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Name | JENNIFER ANOHY GARCIA
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Credential |
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Telephone | 725-266-0616
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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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