Provider Demographics
NPI:1891252292
Name:FIRST WELL SOLUTION
Entity Type:Organization
Organization Name:FIRST WELL SOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABRAHANTES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-666-7836
Mailing Address - Street 1:3365 W CRAIG RD STE 6
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5104
Mailing Address - Country:US
Mailing Address - Phone:702-666-7836
Mailing Address - Fax:
Practice Address - Street 1:3365 W CRAIG RD STE 6
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5104
Practice Address - Country:US
Practice Address - Phone:702-666-7836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV8895OtherCOMM
NVNV3775OtherCOMMERCIAL