| NPI | 1669180659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLIVIA SANTIAGO Administrator 702-780-4327 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2022-11-09 |
| Last Update Date | 2025-04-03 |