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General NPI Number Information
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NPI Number | 1902501448
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Entity Type | Organization
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Legal Business Name | PRIMARY WELLNESS LLC
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 5120 S PECOS RD
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City | LAS VEGAS
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State | NV
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Zip | 89120-1237
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Country | US
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Telephone | 702-576-6102
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Fax | 725-224-0909
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Provider Business Mailing Address
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Address Line | 6720 N HUALAPAI WAY STE 145 BOX 12
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City | LAS VEGAS
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State | NV
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Zip | 89149
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Country | US
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Telephone | 702-576-6102
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Fax | 725-224-0909
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Authorized Official
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Title or Position | MANAGER
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Name | MR. WILLIAM QUIBA
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Credential | NP
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Telephone | 702-576-6102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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