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General NPI Number Information
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NPI Number | 1346514502
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Entity Type | Organization
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Legal Business Name | LSDCCN OF NEVADA LLC
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 9324 SIENNA RIDGE DR
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City | LAS VEGAS
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State | NV
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Zip | 89117-7013
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Country | US
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Telephone | 702-203-1715
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Fax |
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Provider Business Mailing Address
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Address Line | 9324 SIENNA RIDGE DR
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City | LAS VEGAS
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State | NV
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Zip | 89117-7013
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Country | US
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Telephone | 702-203-1715
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ZAFRIR DIAMANT
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Credential |
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Telephone | 702-203-1715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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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 | 251F00000X
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Taxonomy Name | Home Infusion 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 | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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