=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740906692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NET CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2022
-----------------------------------------------------
Last Update Date | 10/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3216 W CHARLESTON BLVD STE C
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89102-1983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-773-0360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1708 DUARTE DR
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89014-3537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-773-0360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | FERNANDO FERNANDEZ SANCHEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-773-0360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------