| NPI | 1770076374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANCES MALINIS Credentialing Specialist 702-410-7825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2018-06-08 |