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General NPI Number Information
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NPI Number | 1205564663
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Entity Type | Organization
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Legal Business Name | QUEENSRIDGE CARDIOLOGY CENTER LLC
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 10040 ALTA DRIVE SUITE 250
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City | LAS VEGAS
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State | NV
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Zip | 89145-8905
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Country | US
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Telephone | 702-589-9250
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Fax | 702-589-9257
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Provider Business Mailing Address
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Address Line | 2779 W HORIZON RIDGE PKWY STE 140
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City | HENDERSON
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State | NV
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Zip | 89052-4186
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Country | US
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Telephone | 702-589-9250
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Fax | 702-589-9257
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROBERT LERMA
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Credential | MS,MBA,CASC
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Telephone | 702-589-9250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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