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General NPI Number Information
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NPI Number | 1972031417
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Entity Type | Organization
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Legal Business Name | CHUYS MEDICAL CLINIC
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Dates
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Enumeration Date | 05/29/2017
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 4225 S EASTERN AVE STE 8
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City | LAS VEGAS
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State | NV
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Zip | 89119-5485
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Country | US
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Telephone | 702-982-5786
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Fax | 702-982-5871
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Provider Business Mailing Address
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Address Line | 4225 S EASTERN AVE STE 8
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City | LAS VEGAS
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State | NV
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Zip | 89119-5485
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Country | US
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Telephone | 702-982-5786
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Fax | 702-982-5871
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Authorized Official
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Title or Position | OWNER
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Name | MR. JESUS CORN-SOTELO
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Credential | PA-C
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Telephone | 702-695-6576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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