| NPI | 1740879188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEILANY GEBA Credentialing Specialist 702-488-4918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2021-01-11 |