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General NPI Number Information
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NPI Number | 1306462742
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Entity Type | Organization
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Legal Business Name | TOTAL CARE MEDICAL GROUP LLC
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 6040 S DURANGO DR STE 115
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City | LAS VEGAS
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State | NV
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Zip | 89113-1792
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Country | US
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Telephone | 310-408-8714
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Fax |
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Provider Business Mailing Address
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Address Line | 3358 HILLSIDE GARDEN DR
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City | LAS VEGAS
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State | NV
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Zip | 89135-2829
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Country | US
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Telephone | 310-408-8714
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHN DOBLE
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Credential |
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Telephone | 310-408-8714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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