Organization
CHOICE FAMILY MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LETANIYA WARREN TATUM (OWNER)
(702) 680-0600
Entity
Organization
Contact information
Practice address
4185 VEGAS VALLEY DR STE C, LAS VEGAS, NV 89121-2522
(702) 463-9066
(702) 463-9067
Mailing address
400 N STEPHANIE ST STE 260, HENDERSON, NV 89014-6800
(702) 629-5555
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2500010169
—
NV
01
—
NV20201837431
STATE OF NEVADA
NV
Enumeration date
07/24/2020
Last updated
04/06/2022
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