| NPI | 1598523276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIVIC BANAL Owner 702-236-2078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2024-03-07 |