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General NPI Number Information
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NPI Number | 1235881939
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Entity Type | Organization
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Legal Business Name | NEVADA MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 3430 E FLAMINGO RD STE 106
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City | LAS VEGAS
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State | NV
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Zip | 89121-5003
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Country | US
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Telephone | 702-929-4796
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Fax |
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Provider Business Mailing Address
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Address Line | 3430 E FLAMINGO RD STE 106
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City | LAS VEGAS
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State | NV
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Zip | 89121-5003
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Country | US
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Telephone | 702-929-4796
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MARIA MARIANO HENRY
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Credential |
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Telephone | 702-929-4796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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