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General NPI Number Information
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NPI Number | 1699336180
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Entity Type | Organization
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Legal Business Name | CANADA MSO LLC
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 8879 W FLAMINGO RD STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89147-8732
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Country | US
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Telephone | 702-646-1150
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Fax |
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Provider Business Mailing Address
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Address Line | 8879 W FLAMINGO RD STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89147-8732
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Country | US
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Telephone | 702-646-1150
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE LEE HARMEL-CANADA
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Credential | DC
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Telephone | 563-940-3806
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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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