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General NPI Number Information
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NPI Number | 1376266833
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Entity Type | Organization
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Legal Business Name | ALTA MEDICAL CLINIC INC OF NEVADA
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 1500 E TROPICANA AVE STE 163
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City | LAS VEGAS
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State | NV
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Zip | 89119-6516
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Country | US
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Telephone | 626-705-1005
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 E TROPICANA AVE STE 163
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City | LAS VEGAS
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State | NV
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Zip | 89119-6516
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Country | US
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Telephone | 626-705-1005
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | GLADELYNN ADLAO
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Credential | APRN
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Telephone | 626-705-1005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry 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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Taxonomy #3
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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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