MEDICARE: SOLACE MEDICAL CENTER CORP

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	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1275497471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLACE MEDICAL CENTER CORP

Provider Business Mailing Address
First Line	:	3430 E FLAMINGO RD STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5064
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 E FLAMINGO RD STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5064
Country	:	US
Telephone Number	:	702-319-4291
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LIU CHIONG RIVERO
Credential	:
Telephone Number	:	702-319-4291

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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Directions to “SOLACE MEDICAL CENTER CORP ” Practice Location

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