Healthcare Provider Details

I. General information

NPI: 1467638668
Provider Name (Legal Business Name): OMAR B CABAHUG MD PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 WIGWAM PKWY SUITE 112
HENDERSON NV
89074-7112
US

IV. Provider business mailing address

2500 WIGWAM PKWY SUITE 112
HENDERSON NV
89074-7112
US

V. Phone/Fax

Practice location:
  • Phone: 702-914-6994
  • Fax: 702-914-5880
Mailing address:
  • Phone: 702-914-6994
  • Fax: 702-914-5880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OMAR B CABAHUG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 702-914-6994