MEDICARE: CLEVER HEALTH CENTER LLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1972125805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVER HEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	3468 E SAHARA AVE STE 160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-4827
Country	:	US
Telephone Number	:	702-625-1492
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 BUSINESS PARK CT STE C
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9007
Country	:	US
Telephone Number	:	702-725-1492
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CARMEN LAZO
Credential	:
Telephone Number	:	702-727-9065

Provider Enumeration Date	:	05/14/2020
Last Update Date	:	05/14/2020

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Directions to “CLEVER HEALTH CENTER LLC ” Practice Location

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