Provider Demographics
NPI:1982922696
Name:WEST LAS VEGAS SCHOOL BASED HEALTH CENTER
Entity Type:Organization
Organization Name:WEST LAS VEGAS SCHOOL BASED HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-426-2564
Mailing Address - Street 1:179 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3495
Mailing Address - Country:US
Mailing Address - Phone:505-426-2564
Mailing Address - Fax:505-426-2579
Practice Address - Street 1:1024 SOUTH PACIFIC
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701
Practice Address - Country:US
Practice Address - Phone:505-426-2564
Practice Address - Fax:505-426-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM261QS1000X261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health