Basic Information
| Provider Information | |||||||||
| NPI: | 1992191779 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FACE TO FACE MEDICAL MANAGEMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 370644 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891370644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023606003 | ||||||||
| FaxNumber: | 7023606006 | ||||||||
| Practice Location | |||||||||
| Address1: | 7336 W POST RD STE 109 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891136647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023606003 | ||||||||
| FaxNumber: | 7023606006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2015 | ||||||||
| LastUpdateDate: | 06/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | FREEDMAN | ||||||||
| AuthorizedOfficialFirstName: | DONIELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7023606003 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.