Provider Demographics
NPI:1710691985
Name:DOWNING CLINIC PLLC
Entity Type:Organization
Organization Name:DOWNING CLINIC PLLC
Other - Org Name:THE DOWNING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:650-520-1078
Mailing Address - Street 1:8323 GARDENA HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8200
Mailing Address - Country:US
Mailing Address - Phone:650-520-1078
Mailing Address - Fax:225-437-3292
Practice Address - Street 1:9777 BERMUDA RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-3571
Practice Address - Country:US
Practice Address - Phone:650-520-1078
Practice Address - Fax:225-437-3292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912419052Medicaid