NPI | 1427635408 |
---|---|
Entity Type | Organization |
Authorized Contact | LYNN PANGALLO Accounting Manager Credentialing 702-375-5777 |
Organization Subpart ? | No |
Primary Taxonomy | 207R00000X Internal Medicine |
Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
207QA0505X Family Medicine, Adult Medicine | |
208VP0000X Pain Medicine, Pain Medicine | |
Enumeration Date | 2021-03-25 |
Last Update Date | 2023-02-28 |