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General NPI Number Information
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NPI Number | 1497432793
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Entity Type | Organization
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Legal Business Name | NEVADA ALWAYS YOUR DOCTOR LLC.
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 4580 S EASTERN AVE STE 29
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City | LAS VEGAS
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State | NV
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Zip | 89119-6100
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Country | US
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Telephone | 702-826-0956
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Fax |
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Provider Business Mailing Address
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Address Line | 4580 S EASTERN AVE STE 29
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City | LAS VEGAS
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State | NV
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Zip | 89119-6100
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Country | US
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Telephone | 702-826-0956
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THERESA SIMPORIOS MONTECILLO
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Credential | NURSE PRACTITIONER
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Telephone | 702-826-0959
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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