| Ebonny Ventures Llc | |
|
1721 E Charleston Blvd Las Vegas NV 89104-1902 | |
| (702) 515-9680 | |
| Not Available |
| Full Name | Ebonny Ventures Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1721 E Charleston Blvd, Las Vegas, Nevada |
| Authorized Official Name and Position | Valando Sterling (OWNER/DIRECTOR) |
| Authorized Official Contact | 7025159680 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebonny Ventures Llc 1721 E Charleston Blvd Las Vegas NV 89104-1902 Ph: (702) 515-9680 | Ebonny Ventures Llc 1721 E Charleston Blvd Las Vegas NV 89104-1902 Ph: (702) 515-9680 |
| NPI Number | 1023680154 |
|---|---|
| Provider Enumeration Date | 07/16/2021 |
| Last Update Date | 07/16/2021 |
| Certification Date | 07/16/2021 |
| Medicare PECOS PAC ID | 2668876590 |
|---|---|
| Medicare Enrollment ID | O20210813002055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023680154 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Festus O Ebonka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932241007 PECOS PAC ID: 3971609512 Enrollment ID: I20150513000946 |
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