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NPI Code Detail

MEDICARE: DIAMOND CMHC

MEDICARE: DIAMOND CMHC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1669298931
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIAMOND CMHC
Provider Business Mailing Address
First Line : 5530 S JONES BLVD # NV
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-0566
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5530 S JONES BLVD # NV
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-0566
Country : US
Telephone Number : 415-299-9782
Fax Number :
Authorized Official
Title or Position : CEO
Name : DEMNA GVAGVALIA
Credential :
Telephone Number : 415-299-9782
Provider Enumeration Date : 12/02/2024
Last Update Date : 12/04/2024

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Directions to “DIAMOND CMHC ” Practice Location

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