Healthcare Provider Details

I. General information

NPI: 1922147354
Provider Name (Legal Business Name): PHILIP FLOTH CST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 BAYCHESTER DR
HENDERSON NV
89015-3633
US

IV. Provider business mailing address

1325 BAYCHESTER DR
HENDERSON NV
89015-3633
US

V. Phone/Fax

Practice location:
  • Phone: 702-558-7823
  • Fax: 702-558-9743
Mailing address:
  • Phone: 702-558-7823
  • Fax: 702-558-9743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number050242
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: