MEDICARE: CHOICE HEALTH PALACE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	208000000X	Pediatrics Physician
3	261QH0100X	Health Service Clinic/Center
4	261QU0200X	Urgent Care Clinic/Center
5	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1962079301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICE HEALTH PALACE LLC

Provider Business Mailing Address
First Line	:	631 N STEPHANIE ST # 260
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-2633
Country	:	US
Telephone Number	:	702-250-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 S RANCHO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-6400
Country	:	US
Telephone Number	:	702-463-9066
Fax Number	:	702-463-9067

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LETANIYA WARREN
Credential	:
Telephone Number	:	702-686-0600

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	07/21/2021

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Directions to “CHOICE HEALTH PALACE LLC ” Practice Location

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