MEDICARE: FIRST WELL SOLUTION

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8895	OTHER	NV	COMM
2	NV3775	OTHER	NV	COMMERCIAL

General Provider Information

NPI Number	:	1891252292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST WELL SOLUTION

Provider Business Mailing Address
First Line	:	3365 W CRAIG RD STE 6
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5104
Country	:	US
Telephone Number	:	702-666-7836
Fax Number	:

Provider Business Practice Location Address
First Line	:	3365 W CRAIG RD STE 6
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5104
Country	:	US
Telephone Number	:	702-666-7836
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSE A ABRAHANTES
Credential	:	RN
Telephone Number	:	702-666-7836

Provider Enumeration Date	:	02/22/2019
Last Update Date	:	02/22/2019

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Directions to “FIRST WELL SOLUTION ” Practice Location

Language	Start Address	Practice Location

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