| NPI | 1649923400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE CARILLO Credentialing 702-569-7244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease |
| 207R00000X Internal Medicine | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2022-02-01 |