Provider Demographics
NPI:1700485083
Name:FAITH MEDICAL CLINIC, LLC.
Entity Type:Organization
Organization Name:FAITH MEDICAL CLINIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONCADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-902-3039
Mailing Address - Street 1:3510 E TROPICANA AVE STE K
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7341
Mailing Address - Country:US
Mailing Address - Phone:702-466-0069
Mailing Address - Fax:702-433-1815
Practice Address - Street 1:3510 E TROPICANA AVE STE K
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7341
Practice Address - Country:US
Practice Address - Phone:702-466-0069
Practice Address - Fax:702-433-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty