| NPI | 1245781160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROYA BEUOKAGHAEI Credentialing Supervisor 702-410-7825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2023-10-27 |