Provider Demographics
NPI:1194223495
Name:NEWWAY NEUROTHERAPY HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:NEWWAY NEUROTHERAPY HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEYKY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-742-8235
Mailing Address - Street 1:5005 SANTO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-1334
Mailing Address - Country:US
Mailing Address - Phone:702-742-8235
Mailing Address - Fax:
Practice Address - Street 1:5130 S PECOS RD STE 1B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-1248
Practice Address - Country:US
Practice Address - Phone:702-410-5090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20181040026OtherSTATE BUSINESS LICENSE