| NPI | 1902501448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM QUIBA Manager 702-576-6102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-11-29 |