| NPI | 1194915785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRICIA MICHELLE MALDONADO Office Manager 702-733-8871 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NV 5104) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2013-05-10 |