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General NPI Number Information
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NPI Number | 1598943029
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Entity Type | Organization
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Legal Business Name | REDICARE LLC
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 1485 E FLAMINGO RD
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City | LAS VEGAS
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State | NV
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Zip | 89119-5256
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Country | US
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Telephone | 702-835-5866
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Fax | 702-835-5865
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Provider Business Mailing Address
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Address Line | 1485 E FLAMINGO RD
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City | LAS VEGAS
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State | NV
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Zip | 89119-5256
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Country | US
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Telephone | 702-835-5866
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Fax | 702-835-5865
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Authorized Official
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Title or Position | PART OWNER
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Name | HUMBERTO RODRIGUEZ JR.
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Credential | MD
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Telephone | 702-835-5866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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