Provider Demographics
NPI:1164228540
Name:HEALTHPRO CLINIC
Entity type:Organization
Organization Name:HEALTHPRO CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER JANE
Authorized Official - Middle Name:VERANO
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FNP
Authorized Official - Phone:818-836-1955
Mailing Address - Street 1:1515 E TROPICANA AVE STE 375
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6520
Mailing Address - Country:US
Mailing Address - Phone:818-836-1955
Mailing Address - Fax:
Practice Address - Street 1:1515 E TROPICANA AVE STE 375
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6520
Practice Address - Country:US
Practice Address - Phone:818-836-1955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty