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General NPI Number Information
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NPI Number | 1811715774
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Entity Type | Organization
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Legal Business Name | DESERT PAIN & WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 2000 S EASTERN AVE # C
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City | LAS VEGAS
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State | NV
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Zip | 89104-4100
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Country | US
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Telephone | 725-251-5308
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 S EASTERN AVE # C
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City | LAS VEGAS
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State | NV
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Zip | 89104-4100
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | LAURIE LADUCA
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Credential |
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Telephone | 845-702-2711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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