Provider Demographics
NPI:1871234609
Name:ELKO REPLENISH MED SPA
Entity Type:Organization
Organization Name:ELKO REPLENISH MED SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CERVANTES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:775-400-1660
Mailing Address - Street 1:1775 BROWNING WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8338
Mailing Address - Country:US
Mailing Address - Phone:775-400-1660
Mailing Address - Fax:721-201-5289
Practice Address - Street 1:1775 BROWNING WAY STE 102
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8338
Practice Address - Country:US
Practice Address - Phone:775-400-1660
Practice Address - Fax:721-201-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care