Provider Demographics
NPI:1407656374
Name:FAMILY HEALTH CLINIC
Entity type:Organization
Organization Name:FAMILY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REYNANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAHERMOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-885-6457
Mailing Address - Street 1:6330 W FLAMINGO RD UNIT 106
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2234
Mailing Address - Country:US
Mailing Address - Phone:702-918-2800
Mailing Address - Fax:702-947-5352
Practice Address - Street 1:6330 W FLAMINGO RD UNIT 106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2234
Practice Address - Country:US
Practice Address - Phone:702-918-2800
Practice Address - Fax:702-947-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QA3000XAmbulatory Health Care FacilitiesClinic/CenterAugmentative Communication
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250023170Medicaid