| NPI | 1215402672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA RIOS Credentialing Specialist 702-310-9110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2019-10-09 |