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General NPI Number Information
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NPI Number | 1851080147
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Entity Type | Organization
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Legal Business Name | HEALTHY YOU MEDICAL GROUP LLC
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 8290 W SAHARA AVE STE 152
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City | LAS VEGAS
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State | NV
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Zip | 89117-8932
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Country | US
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Telephone | 702-900-9753
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Fax | 702-900-9982
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Provider Business Mailing Address
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Address Line | 8290 W SAHARA AVE STE 152
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City | LAS VEGAS
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State | NV
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Zip | 89117-8932
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Country | US
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Telephone | 702-425-0172
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. IRENEO LAZO GUIKING JR.
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Credential | APRN
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Telephone | 702-425-0172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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