Provider Demographics
NPI:1689402448
Name:SAN ALBERTO HEALTH CENTER LLC
Entity type:Organization
Organization Name:SAN ALBERTO HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANOY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOTE-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-373-3529
Mailing Address - Street 1:2820 W CHARLESTON BLVD STE 29
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2820 W CHARLESTON BLVD STE 29
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1933
Practice Address - Country:US
Practice Address - Phone:702-373-3529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center