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General NPI Number Information
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NPI Number | 1295559615
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Entity Type | Organization
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Legal Business Name | TCM FOR WELLNESS LLC
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 5120 S PECOS RD
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City | LAS VEGAS
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State | NV
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Zip | 89120-1237
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Country | US
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Telephone | 725-332-4294
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Fax | 725-224-0909
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Provider Business Mailing Address
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Address Line | 5120 S PECOS RD
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City | LAS VEGAS
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State | NV
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Zip | 89120-1237
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Country | US
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Telephone | 725-332-4294
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Fax | 725-224-0909
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Authorized Official
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Title or Position | APRN
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Name | WILLIAM V QUIBA
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Credential |
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Telephone | 725-332-4294
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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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