MEDICARE: STEM CELL THERAPY OF LAS VEGAS

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1245602390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEM CELL THERAPY OF LAS VEGAS

Provider Business Mailing Address
First Line	:	7231 S EASTERN AVE
Second Line	:	SUITE 167
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0451
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 E FLAMINGO RD STE 333
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5190
Country	:	US
Telephone Number	:	702-936-4770
Fax Number	:	702-936-4761

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	LAMBERT R ABEYATUNGE
Credential	:	MD
Telephone Number	:	702-936-4770

Provider Enumeration Date	:	10/28/2015
Last Update Date	:	12/14/2015

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