Provider Demographics
NPI:1669585964
Name:WEST LAS VEGAS SURGERY CENTER,LLC
Entity type:Organization
Organization Name:WEST LAS VEGAS SURGERY CENTER,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-675-4600
Mailing Address - Street 1:1330 S VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1865
Mailing Address - Country:US
Mailing Address - Phone:702-675-4600
Mailing Address - Fax:702-675-4604
Practice Address - Street 1:1330 S VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1865
Practice Address - Country:US
Practice Address - Phone:702-675-4600
Practice Address - Fax:702-675-4604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508300Medicaid
NVV100448Medicare ID - Type Unspecified