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NPI Code Detail

MEDICARE: GAY AND LESBIAN COMMUNITY CENTER OF SOUTHERN NEVADA INC

MEDICARE: GAY AND LESBIAN COMMUNITY CENTER OF SOUTHERN NEVADA 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
1208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1821741299
Entity Type Code : Organization
Provider Name (Legal Business Name) : GAY AND LESBIAN COMMUNITY CENTER OF SOUTHERN NEVADA INC
Provider Business Mailing Address
First Line : 401 S MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-7206
Country : US
Telephone Number : 702-733-9800
Fax Number :
Provider Business Practice Location Address
First Line : 401 S MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-7206
Country : US
Telephone Number : 702-733-9800
Fax Number : 702-733-9550
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : LATASHA PITTMAN
Credential :
Telephone Number : 512-623-6995
Provider Enumeration Date : 01/27/2022
Last Update Date : 06/27/2024

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Directions to “GAY AND LESBIAN COMMUNITY CENTER OF SOUTHERN NEVADA INC ” Practice Location

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