Organization
EAST CHARELSTON PAIN CLINIC AND MEDICAL CENTER
Active
Parent organization
EBONNY VENTURES INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EBONNY VENTURES INC
Authorized official
FESTUS EBONKA (PRESIDENT)
(702) 515-9680
Entity
Organization
Contact information
Practice address
1721 E CHARLESTON BLVD, LAS VEGAS, NV 89104-1902
(702) 515-9680
Mailing address
1721 E CHARLESTON BLVD, LAS VEGAS, NV 89104-1902
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
03/26/2013
Last updated
03/26/2013
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