| NPI | 1912668617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RELINDIS TAKU Authorized Official 702-403-4770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QH0100X Clinic/Center Health Service | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QM2500X Clinic/Center Medical Specialty | |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2023-02-08 |