MEDICARE: SWEET PEACE 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1205553740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWEET PEACE LLC

Provider Business Mailing Address
First Line	:	2109 WINDHURST ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-4826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2109 WINDHURST ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-4826
Country	:	US
Telephone Number	:	725-266-0616
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JENNIFER ANOHY GARCIA
Credential	:
Telephone Number	:	725-266-0616

Provider Enumeration Date	:	10/25/2022
Last Update Date	:	10/25/2022

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Directions to “SWEET PEACE LLC ” Practice Location

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