MEDICARE: RENELIE SUBA KHOURY RT

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	227800000X	Certified Respiratory Therapist	RC#1717	NV

General Provider Information

NPI Number	:	1730402967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENELIE SUBA KHOURY RT

Provider Business Mailing Address
First Line	:	P.O. BOX 777851
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89077-7851
Country	:	US
Telephone Number	:	702-839-1114
Fax Number	:	702-380-1081

Provider Business Practice Location Address
First Line	:	6070 S. FORT APACHE RD.
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89148
Country	:	US
Telephone Number	:	702-839-1114
Fax Number	:	702-380-1081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2010
Last Update Date	:	06/07/2024

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