| NPI | 1770458499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSSA MARIE OLIVA Administrator 702-806-1456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2025-10-10 |
| Last Update Date | 2025-10-10 |