Provider Demographics
NPI:1669928040
Name:CISEK, ADAM (RD, LD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:CISEK
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E FLAMINGO RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5122
Mailing Address - Country:US
Mailing Address - Phone:702-382-8841
Mailing Address - Fax:702-369-2370
Practice Address - Street 1:2121 E FLAMINGO RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5122
Practice Address - Country:US
Practice Address - Phone:702-382-8841
Practice Address - Fax:702-369-2370
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39048-PDT-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered