Provider Demographics
NPI:1942657473
Name:LIVING LIFE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:LIVING LIFE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWENS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:702-449-4889
Mailing Address - Street 1:7720 W SAHARA AVE
Mailing Address - Street 2:STE 111
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2799
Mailing Address - Country:US
Mailing Address - Phone:702-254-9014
Mailing Address - Fax:702-254-9016
Practice Address - Street 1:7720 W SAHARA AVE
Practice Address - Street 2:STE 111
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2799
Practice Address - Country:US
Practice Address - Phone:702-254-9014
Practice Address - Fax:702-254-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV208VP0000X, 261QP2300X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care