MEDICARE: JONATHAN R. SORELLE, MD., PLLC

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1952829673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN R. SORELLE, MD., PLLC

Provider Business Mailing Address
First Line	:	9080 W POST RD # 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9080 W POST RD # 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2419
Country	:	US
Telephone Number	:	702-739-4263
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	FRANCES MALINIS
Credential	:
Telephone Number	:	702-410-7825

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	09/01/2017

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