| Metabolic Restoration Llc | |
|
8879 W Flamingo Rd Ste 102 Las Vegas NV 89147-8732 | |
| (702) 646-1150 | |
| (702) 646-1152 |
| Full Name | Metabolic Restoration Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 8879 W Flamingo Rd Ste 102, Las Vegas, Nevada |
| Authorized Official Name and Position | Han Nan Paige Chong (OFFICER) |
| Authorized Official Contact | 5633408729 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Metabolic Restoration Llc 8879 W Flamingo Rd Ste 102 Las Vegas NV 89147-8732 Ph: (702) 646-1150 | Metabolic Restoration Llc 8879 W Flamingo Rd Ste 102 Las Vegas NV 89147-8732 Ph: (702) 646-1150 |
| NPI Number | 1457000192 |
|---|---|
| Provider Enumeration Date | 03/21/2022 |
| Last Update Date | 03/21/2022 |
| Medicare PECOS PAC ID | 4284021627 |
|---|---|
| Medicare Enrollment ID | O20220503001922 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457000192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Ivan Goldsmith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073614095 PECOS PAC ID: 1052572294 Enrollment ID: I20120413000574 |
| Provider Name | Darryl L Fortson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538255823 PECOS PAC ID: 4587615471 Enrollment ID: I20150330000417 |
| Provider Name | Marichu Pizan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497131668 PECOS PAC ID: 4880993856 Enrollment ID: I20160425002340 |
| Provider Name | Nicole L Harmel |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1811092240 PECOS PAC ID: 9436196862 Enrollment ID: I20180726001798 |
| Provider Name | Annette Asbury |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659812212 PECOS PAC ID: 8628345295 Enrollment ID: I20180730001554 |
| Provider Name | Amandeep Kaur Phangureh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760198469 PECOS PAC ID: 8426405838 Enrollment ID: I20231107001513 |
| Provider Name | Kimberly Bacolor Gonzales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497532691 PECOS PAC ID: 2466809264 Enrollment ID: I20231116001546 |
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