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Specialty details in registry · Las Vegas, NV

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At a glance

4149 Jory Trl, Las Vegas, NV 89108-5206

NPPES record updated Jun 6, 2019. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

4149 Jory Trl
Las Vegas, NV 89108-5206
Professional details: NPI, taxonomy & registry record
NPI1063071728
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
311500000X
Enumeration date
Jun 6, 2019
Record updated
Jun 6, 2019
More registry details
Provider type
Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

311500000X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

4149 Jory Trl
Las Vegas, NV 89108-5206
Phone
(702) 655-7175
Fax
(702) 655-7175
Mailing address
4125 N BUTLER ST

LAS VEGAS, NV 891294864
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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