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NPI Code Detail

MEDICARE: PACIFICA VINTAGE PARK LLC

MEDICARE: PACIFICA VINTAGE PARK 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
1311500000XAlzheimer Center (Dementia Center)

General Provider Information

NPI Number : 1851990691
Entity Type Code : Organization
Provider Name (Legal Business Name) : PACIFICA VINTAGE PARK LLC
Provider Business Mailing Address
First Line : 7230 GAGNIER BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-4400
Country : US
Telephone Number : 702-263-6313
Fax Number :
Provider Business Practice Location Address
First Line : 7230 GAGNIER BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-4400
Country : US
Telephone Number : 702-263-6313
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DEEPAK ISRANI
Credential :
Telephone Number : 619-296-9000
Provider Enumeration Date : 10/22/2020
Last Update Date : 10/22/2020

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Directions to “PACIFICA VINTAGE PARK LLC ” Practice Location

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