MEDICARE: FALCON VENTURES 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	291U00000X	Clinical Medical Laboratory	E0449642014-7	NV

General Provider Information

NPI Number	:	1831625383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALCON VENTURES LLC

Provider Business Mailing Address
First Line	:	7695 DESPERADO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3346
Country	:	US
Telephone Number	:	908-256-9583
Fax Number	:

Provider Business Practice Location Address
First Line	:	7695 DESPERADO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3346
Country	:	US
Telephone Number	:	908-256-9583
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. PAUL SENDRO
Credential	:
Telephone Number	:	908-256-9583

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	05/03/2017

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