Provider Demographics
NPI:1780096776
Name:ALFORQUE TAN LLC
Entity type:Organization
Organization Name:ALFORQUE TAN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RHIGEL
Authorized Official - Middle Name:ALFORQUE
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP APRN PMHNP
Authorized Official - Phone:702-227-4165
Mailing Address - Street 1:6759 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-2002
Mailing Address - Country:US
Mailing Address - Phone:702-227-4165
Mailing Address - Fax:702-227-7921
Practice Address - Street 1:6759 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2002
Practice Address - Country:US
Practice Address - Phone:702-227-4165
Practice Address - Fax:702-227-7921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN0007124261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)