Healthcare Provider Details

I. General information

NPI: 1477664423
Provider Name (Legal Business Name): NARAG FALLON FAMILY CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 NEW RIVER PKWY
FALLON NV
89406-6894
US

IV. Provider business mailing address

PO BOX 615
FALLON NV
89407-0615
US

V. Phone/Fax

Practice location:
  • Phone: 775-428-2747
  • Fax: 775-428-2179
Mailing address:
  • Phone: 775-428-2747
  • Fax: 775-428-2179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8884
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8787
License Number StateNV

VIII. Authorized Official

Name: DR. REYNALDO B NARAG JR.
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: M.D.
Phone: 775-428-2747