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2620 Regatta Dr Ste 102 Las Vegas NV 89128-6892 | |
| (702) 849-3750 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2620 Regatta Dr Ste 102, Las Vegas, Nevada |
| Authorized Official Name and Position | Silke E Rudolf-andre (OWNER/MANAGER) |
| Authorized Official Contact | 7024752080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2251 N Rampart Blvd Ste 194 Las Vegas NV 89128-7640 Ph: (702) 475-2080 | 2620 Regatta Dr Ste 102 Las Vegas NV 89128-6892 Ph: (702) 849-3750 |
| NPI Number | 1669040937 |
|---|---|
| Provider Enumeration Date | 06/14/2021 |
| Last Update Date | 01/29/2022 |
| Certification Date | 01/29/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669040937 | NPI | - | NPPES |
| 1598106080 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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