Organization
VEGAS INNOVATIVE PSYCHIATRY
Active
Other names
Vegas Innovative Psychiatry
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA FERNANDA MITCHELL (PROGRAM DIRECTOR)
(702) 580-1850
Entity
Organization
Contact information
Practice address
1721 E CHARLESTON BLVD, LAS VEGAS, NV 89104-1902
(702) 685-0620
(702) 685-9674
Mailing address
1721 E CHARLESTON BLVD, LAS VEGAS, NV 89104-1902
(702) 685-0620
(702) 685-9674
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E6055912020-0
—
NV
Enumeration date
04/24/2020
Last updated
08/03/2020
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