Provider Demographics
NPI:1437798931
Name:LAS VEGAS DIAGNOSTIC & TREATMENT LLC
Entity Type:Organization
Organization Name:LAS VEGAS DIAGNOSTIC & TREATMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:DIMURO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:775-842-5742
Mailing Address - Street 1:4158 KERBEROS AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-4717
Mailing Address - Country:US
Mailing Address - Phone:775-842-5742
Mailing Address - Fax:
Practice Address - Street 1:DPM
Practice Address - Street 2:5650 W FLAMINGO RD STE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103
Practice Address - Country:US
Practice Address - Phone:702-365-1987
Practice Address - Fax:702-871-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty