| NPI | 1720762479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARITES GALLO CASTILLO BUSTAMANTE Manager 702-956-1989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-06-13 |
| Last Update Date | 2023-07-03 |