Provider Demographics
NPI:1609684380
Name:BRIGHT HORIZON MEDICAL CENTER LLC
Entity type:Organization
Organization Name:BRIGHT HORIZON MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ODELAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:AREVALO BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-661-6416
Mailing Address - Street 1:4521 E BONANZA RD APT 258
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-3395
Mailing Address - Country:US
Mailing Address - Phone:702-661-6416
Mailing Address - Fax:
Practice Address - Street 1:4521 E BONANZA RD APT 258
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-3395
Practice Address - Country:US
Practice Address - Phone:702-661-6416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty