| Radiance Ketamine Clinic | |
|
6380 Mae Anne Ave Unit 7 Reno NV 89523-4712 | |
| (775) 432-1500 | |
| (775) 432-1002 |
| Full Name | Radiance Ketamine Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 6380 Mae Anne Ave, Reno, Nevada |
| Authorized Official Name and Position | Greg Jones (CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 7754321500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiance Ketamine Clinic 6380 Mae Anne Ave Unit 7 Reno NV 89523-4712 Ph: (775) 432-1500 | Radiance Ketamine Clinic 6380 Mae Anne Ave Unit 7 Reno NV 89523-4712 Ph: (775) 432-1500 |
| NPI Number | 1861036063 |
|---|---|
| Provider Enumeration Date | 10/30/2019 |
| Last Update Date | 04/24/2024 |
| Medicare PECOS PAC ID | 4880016617 |
|---|---|
| Medicare Enrollment ID | O20200623003156 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861036063 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Francisco L Dofeliz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891043832 PECOS PAC ID: 3577712108 Enrollment ID: I20120925000693 |
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