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General NPI Number Information
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NPI Number | 1750792990
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Entity Type | Organization
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Legal Business Name | HEALTHY KIDS PEDIATRICS LLC
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Dates
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Enumeration Date | 05/09/2014
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 3196 S MARYLAND PKWY 400
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City | LAS VEGAS
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State | NV
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Zip | 89109-2305
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Country | US
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Telephone | 702-902-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 3196 S MARYLAND PKWY 400
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City | LAS VEGAS
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State | NV
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Zip | 89109-2305
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Country | US
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Telephone | 702-902-4060
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | LESA BROOKES
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Credential |
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Telephone | 702-902-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 13821
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License Number State | NV
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