| NPI | 1679379572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN PEDRAZA Member 702-629-0245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-03-24 |