Healthcare Provider Details

I. General information

NPI: 1629455985
Provider Name (Legal Business Name): MD24 NV, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 NORTH TOWN CENTER DR STE 100
LAS VEGAS NV
89144
US

IV. Provider business mailing address

14780 W MOUNTAIN VIEW BLVD. SUITE 110
SURPRISE AZ
85374-7280
US

V. Phone/Fax

Practice location:
  • Phone: 623-374-7774
  • Fax:
Mailing address:
  • Phone: 623-374-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LINH C NGUYEN
Title or Position: CEO
Credential: MD
Phone: 623-374-7774