| NPI | 1053963256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENEVE RODRIGUEZ Credentialing Specialist 702-752-2134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 208D00000X General Practice |
| 261QC1500X Clinic/Center, Community Health | |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2022-10-24 |