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Other Service Providers Specialist

Provider NPI: 1649269986

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
Tel: 702-227-1916  Fax: 702-256-7656

Business Mailing Address:
Tel: 702-227-1916  Fax: 702-256-7656

NPI Information:
NPI: 1649269986
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y174400000XOther Service Providers
Internal Medicine

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 174400000X





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