Johanna S. Fricke, M.d., Llc
Developmental - Behavioral Pediatrics
Johanna S. Fricke, M.d., Llc is a Las Vegas, Nevada based Pediatric center with medical specialization in
Developmental - Behavioral Pediatrics.
It is located at
1300 Premier Ct, Las Vegas, Nevada - 89117-7134. They can be contacted on phone at
702-804-9065 and fax number 702-877-2521.
NPI number (Unique professional ID) for Johanna S. Fricke, M.d., Llc is
1790108264 which was assigned by NPPES on 03 Feb, 2014 and it was last updated on 07 Mar, 2023.
Johanna S. Fricke, M.d., Llc is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development.
Complete Profile:
Johanna S. Fricke, M.d., Llc basic information including their official name, gender, specialization, credentials etc. are as mentioned below.
| Specialization : | Pediatrics, Developmental - Behavioral Pediatrics |
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| Provider Name : | Johanna S. Fricke, M.d., Llc |
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Business Address:
Johanna S. Fricke, M.d., Llc address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.
| Primary Address : | 1300 Premier Ct
Las Vegas, NV, 89117-7134
United States |
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| Phone Number : | 702-804-9065 |
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| Fax Number : | 702-877-2521 |
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Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.
| NPI Number : | 1790108264 |
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| NPI Entity Type : | Organization |
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| First Enrolment Date : | 03 Feb, 2014 |
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| Last Updated On : | 07 Mar, 2023 |
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Authorized Official Details:
Officially authorized person to contact for any management issues or complaints of this organization are as below. Person's position and contact details are as mentioned below.
| Authorized Official Name : | Johanna Fricke |
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| Authorized Official Credential : | M.D. |
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| Official Title or Position : | Physician/CEO |
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| Phone Number : | 7028049065 |
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Licenses and Specialities:
Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Johanna S. Fricke, M.d., Llc are as mentioned. Primary taxonomy code for Johanna S. Fricke, M.d., Llc is
2080P0006X (Pediatrics, Developmental - Behavioral Pediatrics).
| Taxonomy Code | Speciality | Primary | License No. | State |
|---|
| 261QD1600X | Clinic/Center, Developmental Disabilities | No | | NV |
| 261QM0855X | Clinic/Center, Adolescent and Children Mental Health | No | | NV |
| 261QM2500X | Clinic/Center, Medical Specialty | No | | NV |
| 2080P0006X | Pediatrics, Developmental - Behavioral Pediatrics | Yes | | NV |
Legacy Identifiers:
Other legacy medical identifiers of Johanna S. Fricke, M.d., Llc such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.
| Identifier | Identifier Type | State | Issuer |
|---|
| 002002223 | MEDICAID | NV | |
| 003102223 | Other (non-Medicare) | NV | MEDICARE ID-Type Unspecified/NV Medicaid |
| 32876 | Other (non-Medicare) | NV | MEDICARE ID-Type Unspecified/Medicare |
| CS09750 | Other (non-Medicare) | NV | State Pharmacy |
| H08729 | MEDICARE UPIN | NV | |
Mailing Address:
Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.
| Mailing Address : | 311 N Buffalo Dr, Suite B
Las Vegas, NV, 89145-0375
United States |
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| Phone Number : | 702-877-2520 |
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| Fax Number : | 702-877-2521 |
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Business Location:
Patients can refer following map for directions to
Johanna S. Fricke, M.d., Llc practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 January, 2024.