MEDICARE: ALLIANCE FOR CHILDHOOD DISEASES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1033820980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE FOR CHILDHOOD DISEASES

Provider Business Mailing Address
First Line	:	10170 W TROPICANA AVE # 156-252
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8465
Country	:	US
Telephone Number	:	702-732-1493
Fax Number	:	702-732-1080

Provider Business Practice Location Address
First Line	:	4425 S PECOS RD STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5037
Country	:	US
Telephone Number	:	702-333-7000
Fax Number	:	702-732-1080

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTINE TONN
Credential	:
Telephone Number	:	702-732-1493

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	02/07/2023

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