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General NPI Number Information
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NPI Number | 1972669661
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Entity Type | Organization
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Legal Business Name | HEALTHWELL MEDICAL GROUP
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4375 S BUFFALO DR #101
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City | LAS VEGAS
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State | NV
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Zip | 89147
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Country | US
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Telephone | 702-894-9422
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Fax | 702-894-9258
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Provider Business Mailing Address
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Address Line | PO BOX 82277
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City | LAS VEGAS
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State | NV
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Zip | 89180
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Country | US
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Telephone | 702-894-9422
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Fax | 702-894-9258
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Authorized Official
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Title or Position | DOCTOR OFFICE MANAGER
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Name | DR. GRACE CANO DEBELEN
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Credential | MD
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Telephone | 702-894-9422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 10005
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 10006
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License Number State | NV
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