MEDICARE: SAFE HARBOR MEDICAL, INC.

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	113458	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	NPI	OTHER	NV	1457320004
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	NPI	OTHER	NV	1932741048

General Provider Information

NPI Number	:	1821290115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE HARBOR MEDICAL, INC.

Provider Business Mailing Address
First Line	:	2901 N TENAYA WAY STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1404
Country	:	US
Telephone Number	:	702-870-8852
Fax Number	:	702-870-8914

Provider Business Practice Location Address
First Line	:	2901 N TENAYA WAY STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1404
Country	:	US
Telephone Number	:	702-870-8852
Fax Number	:	702-870-8914

Authorized Official
Title or Position	:	CEO
Name	:	MS. TINA A ALICEA
Credential	:	MBA
Telephone Number	:	702-870-8852

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	09/02/2025

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Directions to “SAFE HARBOR MEDICAL, INC. ” Practice Location

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