| NPI | 1194949131 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | DIVINA A OBENA Physician 702-649-5683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NV 7308) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-08-22 |