Provider Demographics
NPI:1467753830
Name:INFUSION AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:INFUSION AND WELLNESS CENTER LLC
Other - Org Name:INFUSION AND WELLNESS CENTER OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-434-8880
Mailing Address - Street 1:2940 S JONES BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5630
Mailing Address - Country:US
Mailing Address - Phone:702-735-6209
Mailing Address - Fax:
Practice Address - Street 1:2940 S JONES BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5630
Practice Address - Country:US
Practice Address - Phone:702-735-6209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20101813983261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center