MEDICARE: MAISON LUXARE 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	:	1205714375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAISON LUXARE LLC

Provider Business Mailing Address
First Line	:	840 S RANCHO DR STE 4629
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6490 W DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6609
Country	:	US
Telephone Number	:	702-431-2232
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CARMEN LAZO
Credential	:
Telephone Number	:	702-431-2232

Provider Enumeration Date	:	08/26/2025
Last Update Date	:	08/26/2025

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Directions to “MAISON LUXARE LLC ” Practice Location

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