| 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 |