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NPI Code Detail

MEDICARE: CHUYS MEDICAL CLINIC

MEDICARE: CHUYS MEDICAL CLINIC
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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1972031417
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHUYS MEDICAL CLINIC
Provider Business Mailing Address
First Line : 4225 S EASTERN AVE STE 8
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5485
Country : US
Telephone Number : 702-982-5786
Fax Number : 702-982-5871
Provider Business Practice Location Address
First Line : 4225 S EASTERN AVE STE 8
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5485
Country : US
Telephone Number : 702-982-5786
Fax Number : 702-982-5871
Authorized Official
Title or Position : OWNER
Name : MR. JESUS CORN-SOTELO
Credential : PA-C
Telephone Number : 702-695-6576
Provider Enumeration Date : 05/29/2017
Last Update Date : 03/20/2018

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Directions to “CHUYS MEDICAL CLINIC ” Practice Location

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