| 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 |