Provider Demographics
NPI:1801560495
Name:LAS VEGAS MOBILE CLINIC LLC
Entity type:Organization
Organization Name:LAS VEGAS MOBILE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAUREGUI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-266-7277
Mailing Address - Street 1:1771 E FLAMINGO RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5155
Mailing Address - Country:US
Mailing Address - Phone:702-266-7277
Mailing Address - Fax:
Practice Address - Street 1:1771 E FLAMINGO RD STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5155
Practice Address - Country:US
Practice Address - Phone:702-266-7277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty