Organization
SHAMLOO BLUE SKY TREATMENT CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI LABRECQUE (ACCTS. MGR)
(702) 453-3799
Entity
Organization
Contact information
Practice address
3150 N TENAYA WAY, SUITE 510, LAS VEGAS, NV 89128-0443
(702) 453-3799
Mailing address
PO BOX 370457, LAS VEGAS, NV 89137-0457
(702) 453-3799
(702) 453-5741
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
13639
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13639
NV LIC
NV
Enumeration date
09/27/2013
Last updated
10/29/2013
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