Provider Demographics
NPI:1326753427
Name:LAS VEGAS HEALTH & WELLNESS CANTER, INC.
Entity Type:Organization
Organization Name:LAS VEGAS HEALTH & WELLNESS CANTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANSICO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:MADIEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-884-9984
Mailing Address - Street 1:4567 BIGFORD ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-6154
Mailing Address - Country:US
Mailing Address - Phone:702-884-9984
Mailing Address - Fax:
Practice Address - Street 1:4567 BIGFORD ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6154
Practice Address - Country:US
Practice Address - Phone:702-884-9984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)