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General NPI Number Information
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NPI Number | 1659170496
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Entity Type | Organization
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Legal Business Name | MIND BRIDGET LLC
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 4660 S EASTERN AVE STE 203A
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City | LAS VEGAS
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State | NV
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Zip | 89119-6139
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Country | US
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Telephone | 725-205-0636
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Fax |
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Provider Business Mailing Address
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Address Line | 4660 S EASTERN AVE STE 203A
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City | LAS VEGAS
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State | NV
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Zip | 89119-6139
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DIONNIS AGUILAR TORRES
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Credential |
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Telephone | 725-205-0636
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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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