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General NPI Number Information
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NPI Number | 1306234398
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Entity Type | Organization
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Legal Business Name | INTUITIVE THERAPIES LLC
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 801 S. RANCHO DR. A3
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City | LAS VEGAS
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State | NV
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Zip | 89106
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Country | US
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Telephone | 702-807-4426
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Fax |
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Provider Business Mailing Address
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Address Line | 101 CONVENTION CENTER DR. SUITE #100
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City | LAS VEGAS
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State | NV
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Zip | 89109
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Country | US
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Telephone | 702-807-4426
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. TONIIKA DIONE WAKEFIELD
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Credential | LMT, NCBTMB
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Telephone | 702-807-4426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | NVMT 5017
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License Number State | NV
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