MEDICARE: ALLINA VICTORIA WARD

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1932669322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLINA VICTORIA WARD

Provider Business Mailing Address
First Line	:	3700 PECOS MCLEOD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4259
Country	:	US
Telephone Number	:	702-547-5599
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 PECOS MCLEOD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4259
Country	:	US
Telephone Number	:	702-547-5599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	03/21/2019

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