MEDICARE: VALLEY PAIN & WELLNESS 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	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1720957111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY PAIN & WELLNESS LLC

Provider Business Mailing Address
First Line	:	2121 E FLAMINGO RD STE 208
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5124
Country	:	US
Telephone Number	:	725-326-0451
Fax Number	:	702-268-8950

Provider Business Practice Location Address
First Line	:	2121 E FLAMINGO RD STE 208
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5124
Country	:	US
Telephone Number	:	702-430-1112
Fax Number	:	702-268-8950

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. RONALD LEE MOORE
Credential	:
Telephone Number	:	702-430-1112

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

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