Organization
GENESIS MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YUSLEISY COLLAZO (OWNER)
(702) 981-4012
Entity
Organization
Contact information
Practice address
1372 MONTEZUMA CT, LAS VEGAS, NV 89119-4513
(702) 981-4012
Mailing address
1372 MONTEZUMA CT, LAS VEGAS, NV 89119-4513
(702) 981-4012
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
04/30/2022
Last updated
04/30/2022
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