MEDICARE: PERFECTED SOUND 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	251S00000X	Community/Behavioral Health Agency	NV20181602104	NV

General Provider Information

NPI Number	:	1609357979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFECTED SOUND LLC

Provider Business Mailing Address
First Line	:	6250 W ARBY AVE UNIT 197
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4640
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6250 W ARBY AVE UNIT 197
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4640
Country	:	US
Telephone Number	:	951-966-6151
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN MALACH
Credential	:
Telephone Number	:	951-966-6151

Provider Enumeration Date	:	08/24/2018
Last Update Date	:	08/24/2018

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