Provider Demographics
NPI:1326562075
Name:AMBER FEDERIZO PLLC HEMOSTASIS AND THROMBOSIS CONSULTANTS OF NEVADA
Entity Type:Organization
Organization Name:AMBER FEDERIZO PLLC HEMOSTASIS AND THROMBOSIS CONSULTANTS OF NEVADA
Other - Org Name:HEMOSTASIS AND THROMBOSIS CONSULTANTS OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDERIZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-506-8199
Mailing Address - Street 1:8545 W WARM SPRINGS RD.
Mailing Address - Street 2:A-4 #320
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113
Mailing Address - Country:US
Mailing Address - Phone:702-506-8199
Mailing Address - Fax:
Practice Address - Street 1:4200 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1625
Practice Address - Country:US
Practice Address - Phone:702-506-8199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBER FEDERIZO PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center