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General NPI Number Information
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NPI Number | 1235609140
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Entity Type | Organization
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Legal Business Name | ZANE MEDICAL GROUP LLC
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Dates
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Enumeration Date | 12/04/2018
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 3455 W CRAIG RD STE C
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-5119
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Country | US
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Telephone | 702-773-8673
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Fax |
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Provider Business Mailing Address
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Address Line | 3455 W CRAIG RD STE C
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-5119
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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 | OWNER
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Name | SUSSAN FUNG
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Credential |
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Telephone | 702-773-8673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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