| NPI | 1952652422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY CASTILLO Associate Director Credentialing 702-579-3253 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2024-08-20 |