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General NPI Number Information
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NPI Number | 1386273340
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Entity Type | Organization
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Legal Business Name | PHOENIX BEHAVIORAL GROUP LV LLC
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 1670 E FLAMINGO RD STE B
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City | LAS VEGAS
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State | NV
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Zip | 89119-5120
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Country | US
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Telephone | 702-202-4442
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Fax | 888-857-3788
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Provider Business Mailing Address
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Address Line | 1670 E FLAMINGO RD STE B
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City | LAS VEGAS
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State | NV
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Zip | 89119-5120
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Country | US
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Telephone | 702-202-4442
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Fax | 888-857-3788
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Authorized Official
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Title or Position | MANAGER
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Name | YESICA Y SANCHEZ
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Credential |
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Telephone | 702-202-4442
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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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