| Phenomenal Angels | |
|
3380 E Russell Rd Suite 104 Las Vegas NV 89120-3402 | |
| (702) 476-0448 | |
| (702) 476-0449 |
| Full Name | Phenomenal Angels |
|---|---|
| Speciality | Preferred Provider Organization |
| Location | 3380 E Russell Rd, Las Vegas, Nevada |
| Authorized Official Name and Position | Kimberly Rashone Broussard (OWNER / OPERATOR) |
| Authorized Official Contact | 7028071718 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phenomenal Angels 3380 E Russell Rd Suite 104 Las Vegas NV 89120-3402 Ph: (702) 476-0448 | Phenomenal Angels 3380 E Russell Rd Suite 104 Las Vegas NV 89120-3402 Ph: (702) 476-0448 |
| NPI Number | 1477908275 |
|---|---|
| Provider Enumeration Date | 04/28/2016 |
| Last Update Date | 04/29/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477908275 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
| 305R00000X | Preferred Provider Organization | (* (Not Available)) | Primary |
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