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General NPI Number Information
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NPI Number | 1770085755
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC INTEGRATED MEDICAL CARE INC
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 3111 S MARYLAND PKWY
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City | LAS VEGAS
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State | NV
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Zip | 89109-2331
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Country | US
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Telephone | 702-617-6313
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 71526
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City | LAS VEGAS
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State | NV
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Zip | 89170-1526
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Country | US
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Telephone | 702-617-6313
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | ROXANA VALETON
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Credential |
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Telephone | 305-303-8108
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | NV
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