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General NPI Number Information
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NPI Number | 1639836505
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Entity Type | Organization
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Legal Business Name | CLINICAL SOLUTIONS ASC LL
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Dates
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Enumeration Date | 11/26/2021
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Last Update Date | 11/26/2021
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Provider Practice Location Address
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Address Line | 2529 CHARLEVILLE AVE UNIT 103
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City | LAS VEGAS
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State | NV
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Zip | 89106-1525
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Country | US
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Telephone | 408-761-5847
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Fax |
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Provider Business Mailing Address
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Address Line | 4215 HAMILTON AVE
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City | SAN JOSE
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State | CA
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Zip | 95130-1462
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Country | US
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Telephone | 408-761-5847
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. BARBARA LEE ROTH
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Credential | REGISTERED NURSE
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Telephone | 408-761-5847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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