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General NPI Number Information
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NPI Number | 1669245239
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Entity Type | Organization
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Legal Business Name | INDIVIDUALIZED MINDFUL SOLUTIONS LLC
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Dates
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Enumeration Date | 11/03/2023
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1681 E FLAMINGO RD STE 3
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City | LAS VEGAS
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State | NV
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Zip | 89119-5274
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Country | US
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Telephone | 702-291-8798
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Fax |
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Provider Business Mailing Address
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Address Line | 1681 E FLAMINGO RD STE 3
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City | LAS VEGAS
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State | NV
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Zip | 89119-5274
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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 | PRESIDENT
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Name | LEONIDES GARCIA
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Credential |
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Telephone | 725-247-0388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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