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General NPI Number Information
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NPI Number | 1902710544
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Entity Type | Organization
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Legal Business Name | BRIGHTLIGHT MEDICAL CENTER LLC
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 2755 E DESERT INN RD STE 170E
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City | LAS VEGAS
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State | NV
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Zip | 89121-3625
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Country | US
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Telephone | 702-401-0801
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Fax |
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Provider Business Mailing Address
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Address Line | 2712 HOLMES ST
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City | N LAS VEGAS
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State | NV
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Zip | 89030-5428
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Country | US
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Telephone | 702-401-0801
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Fax |
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Authorized Official
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Title or Position | MEMBER MANAGING
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Name | MICHEL ROQUE UCIO
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Credential | PMHNP
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Telephone | 702-401-0801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NULL
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