Provider Demographics
NPI:1417646860
Name:CITI MED
Entity type:Organization
Organization Name:CITI MED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILA BALSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-852-6470
Mailing Address - Street 1:5440 W SAHARA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0361
Mailing Address - Country:US
Mailing Address - Phone:702-602-5106
Mailing Address - Fax:702-685-7770
Practice Address - Street 1:5440 W SAHARA AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0361
Practice Address - Country:US
Practice Address - Phone:702-602-5106
Practice Address - Fax:702-685-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty