Provider Demographics
NPI:1114710456
Name:NCR MEDICAL AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:NCR MEDICAL AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUBIL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:725-316-3851
Mailing Address - Street 1:4225 S EASTERN AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5485
Mailing Address - Country:US
Mailing Address - Phone:725-316-3851
Mailing Address - Fax:702-552-0302
Practice Address - Street 1:4225 S EASTERN AVE STE 9
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5485
Practice Address - Country:US
Practice Address - Phone:725-316-3851
Practice Address - Fax:702-552-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center