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NPI Code Detail

MEDICARE: ALL STAR MEDICAL RESOURCES LLC

MEDICARE: ALL STAR MEDICAL RESOURCES 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
1207R00000XInternal Medicine Physician
22084B0040XBehavioral Neurology & Neuropsychiatry Physician
3261QM1300XMulti-Specialty Clinic/Center
4208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1245924497
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALL STAR MEDICAL RESOURCES LLC
Provider Business Mailing Address
First Line : 2626 S RAINBOW BLVD # 203A
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-4005
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2626 S RAINBOW BLVD # 203A
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-4005
Country : US
Telephone Number : 877-420-6372
Fax Number :
Authorized Official
Title or Position : CREDENTIALING
Name : TAJ REYES
Credential :
Telephone Number : 907-891-7812
Provider Enumeration Date : 06/08/2023
Last Update Date : 06/08/2023

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Directions to “ALL STAR MEDICAL RESOURCES LLC ” Practice Location

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