MEDICARE: LIFE SCIENCE HEALTH CENTER 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1417381807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE SCIENCE HEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	2 WHITE TAIL CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-6134
Country	:	US
Telephone Number	:	702-487-7055
Fax Number	:	702-991-7258

Provider Business Practice Location Address
First Line	:	6332 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3234
Country	:	US
Telephone Number	:	702-487-7055
Fax Number	:	702-991-7258

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN WOJTASZCZYK
Credential	:
Telephone Number	:	702-487-7055

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/21/2013

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Directions to “LIFE SCIENCE HEALTH CENTER LLC ” Practice Location

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