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General NPI Number Information
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NPI Number | 1881077451
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Entity Type | Organization
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Legal Business Name | DESERT SHORES LLC
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 2235 N RAMPART BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89128-7640
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Country | US
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Telephone | 702-387-8777
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Fax |
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Provider Business Mailing Address
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Address Line | 2235 N RAMPART BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89128-7640
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Country | US
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Telephone | 702-387-8777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TED A COHEN
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Credential | DPM
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Telephone | 702-339-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | DPM9301
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License Number State | NV
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