Organization
GREAT LIFE MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IROSBEL REYES - BLANCO (CEO)
(702) 596-6451
Entity
Organization
Contact information
Practice address
1579 FALLING LEAF LN, LAS VEGAS, NV 89142-1100
(702) 596-6451
Mailing address
1579 FALLING LEAF LN, LAS VEGAS, NV 89142-1100
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
02/15/2023
Last updated
02/15/2023
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