Provider Demographics
NPI:1366127789
Name:ENKI MEDICAL CENTER LLC
Entity type:Organization
Organization Name:ENKI MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUSIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-510-9587
Mailing Address - Street 1:4820 EL ESCORIAL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-6805
Mailing Address - Country:US
Mailing Address - Phone:702-510-9587
Mailing Address - Fax:702-920-7677
Practice Address - Street 1:3606 ALGONQUIN DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3150
Practice Address - Country:US
Practice Address - Phone:702-510-9587
Practice Address - Fax:702-920-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care