| NPI | 1083674246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORRAINE GOMEZ Off Manager 702-870-8855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NV h14-00141-b-120899) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2020-08-22 |