Provider Demographics
NPI:1417590365
Name:COMPREHENSIVE DIABETES SERVICES
Entity Type:Organization
Organization Name:COMPREHENSIVE DIABETES SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMSUMEER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, DNP
Authorized Official - Phone:509-430-9813
Mailing Address - Street 1:PO BOX 2388
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86430-2388
Mailing Address - Country:US
Mailing Address - Phone:509-430-9813
Mailing Address - Fax:
Practice Address - Street 1:514 SENECA RIDGE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-1314
Practice Address - Country:US
Practice Address - Phone:509-430-9813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty