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3620 N Rancho Dr Ste 107 Las Vegas NV 89130-3153 | |
| (702) 499-0379 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3620 N Rancho Dr Ste 107, Las Vegas, Nevada |
| Authorized Official Name and Position | Lynette Martinez (OWNER) |
| Authorized Official Contact | 7024990379 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3620 N Rancho Dr Ste 107 Las Vegas NV 89130-3153 Ph: (702) 499-0379 | 3620 N Rancho Dr Ste 107 Las Vegas NV 89130-3153 Ph: (702) 499-0379 |
| NPI Number | 1306197934 |
|---|---|
| Provider Enumeration Date | 09/21/2012 |
| Last Update Date | 05/14/2020 |
| Certification Date | 05/14/2020 |
| Medicare PECOS PAC ID | 3971855354 |
|---|---|
| Medicare Enrollment ID | O20200515000947 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306197934 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Monique Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063672681 PECOS PAC ID: 5597088021 Enrollment ID: I20160302002224 |
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