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General NPI Number Information
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NPI Number | 1811226400
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL MEDICAL MANAGEMENT, INC.
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 3230 E FLAMINGO RD 334
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City | LAS VEGAS
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State | NV
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Zip | 89121-4320
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Country | US
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Telephone | 702-454-8236
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Fax | 702-454-8279
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Provider Business Mailing Address
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Address Line | 3230 E FLAMINGO RD 334
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City | LAS VEGAS
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State | NV
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Zip | 89121-4320
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Country | US
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Telephone | 702-454-8236
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Fax | 702-454-8279
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. HELEN CHEN
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Credential |
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Telephone | 702-454-8236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 010-1001168755
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License Number State | NV
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