Provider Demographics
NPI:1639820731
Name:ADVANCED MEDICAL INNOVATIONS LLC
Entity type:Organization
Organization Name:ADVANCED MEDICAL INNOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEROTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-843-3782
Mailing Address - Street 1:9570 S MCCARRAN BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9202
Mailing Address - Country:US
Mailing Address - Phone:775-499-5121
Mailing Address - Fax:775-746-2566
Practice Address - Street 1:9570 S MCCARRAN BLVD STE 108
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-9202
Practice Address - Country:US
Practice Address - Phone:775-499-5121
Practice Address - Fax:775-746-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVB01088OtherB01088