MEDICARE: PALLIATIVE CARE OF LAS VEGAS, LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1083501597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALLIATIVE CARE OF LAS VEGAS, LLC

Provider Business Mailing Address
First Line	:	4938 JEREMY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-0104
Country	:	US
Telephone Number	:	702-849-2504
Fax Number	:

Provider Business Practice Location Address
First Line	:	4938 JEREMY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-0104
Country	:	US
Telephone Number	:	702-849-2504
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	ANTHONY BRANDO SO OPIMO
Credential	:	DNP, AGACNP-BC
Telephone Number	:	702-849-2504

Provider Enumeration Date	:	06/18/2025
Last Update Date	:	06/18/2025

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