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Organization

EBENEZER MEDICAL CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
YAREL HERNANDEZ LEON (MANAGING MEMBER)
(702) 515-9926
Entity
Organization

Contact information

Practice address
2619 W CHARLESTON BLVD STE E, LAS VEGAS, NV 89102-2121
(702) 805-3059
Mailing address
305 ANTELOPE WAY, LAS VEGAS, NV 89145-5201
(702) 515-9926

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)

Other

Enumeration date
11/23/2021
Last updated
11/23/2021
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