MEDICARE: NEVADA WHOLENESS THERAPEUTICS

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	163WP0808X	Psychiatric/Mental Health Registered Nurse

General Provider Information

NPI Number	:	1871368506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA WHOLENESS THERAPEUTICS

Provider Business Mailing Address
First Line	:	2920 S RAINBOW BLVD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6214
Country	:	US
Telephone Number	:	702-209-3595
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 S RAINBOW BLVD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6214
Country	:	US
Telephone Number	:	702-209-3595
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERNESTO RODRIGUEZ
Credential	:
Telephone Number	:	702-672-5154

Provider Enumeration Date	:	11/22/2023
Last Update Date	:	11/22/2023

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