Provider Demographics
NPI:1417381807
Name:LIFE SCIENCE HEALTH CENTER LLC
Entity Type:Organization
Organization Name:LIFE SCIENCE HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOJTASZCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-487-7055
Mailing Address - Street 1:2 WHITE TAIL CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6134
Mailing Address - Country:US
Mailing Address - Phone:702-487-7055
Mailing Address - Fax:702-991-7258
Practice Address - Street 1:6332 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3234
Practice Address - Country:US
Practice Address - Phone:702-487-7055
Practice Address - Fax:702-991-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty