| NPI | 1134745722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANLEY KIDIAVAYI Authorized Official 702-761-6457 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2020-06-19 |