| NPI | 1881654093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FABIANA ALFARO Member 702-735-8884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NV 132986) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2020-08-22 |