NPI | 1487461901 |
---|---|
Entity Type | Organization |
Authorized Contact | ROMAN MARDANOV Practice Owner 702-521-2449 |
Organization Subpart ? | No |
Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
Enumeration Date | 2024-12-17 |
Last Update Date | 2025-03-06 |