MEDICARE: DESERTBLOOM MEDICAL 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	:	1376323550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERTBLOOM MEDICAL LLC

Provider Business Mailing Address
First Line	:	931 S 3RD ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6801
Country	:	US
Telephone Number	:	725-256-8020
Fax Number	:

Provider Business Practice Location Address
First Line	:	931 S 3RD ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6801
Country	:	US
Telephone Number	:	725-256-8020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASYA HOVHANNISYAN
Credential	:
Telephone Number	:	725-256-8020

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	10/22/2024

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Directions to “DESERTBLOOM MEDICAL LLC ” Practice Location

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