Organization
OMNI WELLCARE INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY GO (PRESIDENT)
(702) 782-0376
Entity
Organization
Contact information
Practice address
1681 E FLAMINGO RD STE 1, LAS VEGAS, NV 89119-5274
(702) 573-3317
Mailing address
9142 ASPENDALE RANCH CT, LAS VEGAS, NV 89139-7276
Taxonomy
Speciality
Code
Description
License number
State
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
03/07/2025
Last updated
03/07/2025
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