Provider Demographics
NPI:1386967420
Name:1849 LLC
Entity type:Organization
Organization Name:1849 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SORELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-568-0007
Mailing Address - Street 1:PO BOX 33292
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-3292
Mailing Address - Country:US
Mailing Address - Phone:702-568-0007
Mailing Address - Fax:702-568-6299
Practice Address - Street 1:11 W PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7304
Practice Address - Country:US
Practice Address - Phone:702-568-0007
Practice Address - Fax:702-568-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV125622086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12562OtherMEDIAL LICENSE