Provider Demographics
NPI:1336397678
Name:SUMMERLIN HEALTH & WELLNESS
Entity type:Organization
Organization Name:SUMMERLIN HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ALISA
Authorized Official - Last Name:DILAURO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-360-4836
Mailing Address - Street 1:10050 BANBURRY CROSS DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-7056
Mailing Address - Country:US
Mailing Address - Phone:702-360-4836
Mailing Address - Fax:702-946-0866
Practice Address - Street 1:10050 BANBURRY CROSS DR
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-7056
Practice Address - Country:US
Practice Address - Phone:702-360-4836
Practice Address - Fax:702-946-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4910-C1041C0700X
NV109172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty