Healthcare Provider Details

I. General information

NPI: 1053739268
Provider Name (Legal Business Name): UNSOM MULTI-SPEC GRP PRACT S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 SAINT ROSE PKWY SUITE 200
HENDERSON NV
89052-3506
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD SUITE 110
LAS VEGAS NV
89102-2325
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-2211
  • Fax:
Mailing address:
  • Phone: 702-671-2211
  • Fax: 702-380-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number StateNV
# 6
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: DR. WILLIAM A ZAMBONI
Title or Position: PRESIDENT
Credential: MD
Phone: 702-671-2222