Healthcare Provider Details

I. General information

NPI: 1639349418
Provider Name (Legal Business Name): UNIVERSITY OF NEVADA SCHOOL OF MEDICINE MULTI SPECIALTY GROUP SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 SEVEN HILLS DR STE 200
HENDERSON NV
89052-4371
US

IV. Provider business mailing address

PO BOX 98528
LAS VEGAS NV
89193-8528
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-5070
  • Fax: 702-385-3932
Mailing address:
  • Phone: 702-671-6423
  • Fax: 702-671-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number StateNV
# 7
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: WILLIAM A ZAMBONI
Title or Position: PRESIDENT
Credential: MD
Phone: 702-671-2278