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General NPI Number Information
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NPI Number | 1487192183
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Entity Type | Organization
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Legal Business Name | VISITA MEDICAL, LLC.
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 1809 PLAZA DEL CORDERO
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City | LAS VEGAS
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State | NV
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Zip | 89102
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Country | US
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Telephone | 702-287-8172
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Fax | 702-989-8434
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Provider Business Mailing Address
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Address Line | 1809 PLAZA DEL CORDERO
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City | LAS VEGAS
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State | NV
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Zip | 89102
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Country | US
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Telephone | 702-287-8172
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Fax | 702-989-8434
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Authorized Official
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Title or Position | CEO
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Name | MR. JAYJAY M JOSEPH
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Credential | APRN
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Telephone | 702-287-8172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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