| NPI | 1891134615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALIK JENKINS Supervisor 702-218-6271 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NV 305r00000x) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2013-06-14 |