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General NPI Number Information
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NPI Number | 1467753830
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Entity Type | Organization
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Legal Business Name | INFUSION AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 2940 S JONES BLVD STE A
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City | LAS VEGAS
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State | NV
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Zip | 89146-5630
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Country | US
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Telephone | 702-735-6209
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Fax |
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Provider Business Mailing Address
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Address Line | 2940 S JONES BLVD STE A
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City | LAS VEGAS
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State | NV
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Zip | 89146-5630
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Country | US
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Telephone | 702-735-6209
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIE WU
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Credential | MD
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Telephone | 702-434-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | NV20101813983
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License Number State | NV
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