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4252 Vader Ave Studio Las Vegas NV 89120-2138 | |
| (951) 378-5868 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 4252 Vader Ave, Las Vegas, Nevada |
| Authorized Official Name and Position | Sabrina Shireen Santa Clara (OWNER) |
| Authorized Official Contact | 9513785868 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4252 Vader Ave Studio Las Vegas NV 89120-2138 Ph: (951) 378-5868 | 4252 Vader Ave Studio Las Vegas NV 89120-2138 Ph: (951) 378-5868 |
| NPI Number | 1235687575 |
|---|---|
| Provider Enumeration Date | 09/15/2016 |
| Last Update Date | 09/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235687575 | NPI | - | NPPES |
| 1740503267 | Other | NV | NPPES - INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | CP0097 (Nevada) | Primary |
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