Healthcare Provider Details

I. General information

NPI: 1134852957
Provider Name (Legal Business Name): CHRISTIANA OLUWADAMILOLA DAVID M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date: 03/13/2023
Reactivation Date: 03/14/2023

III. Provider practice location address

2704 N TENAYA WAY STE 1100
LAS VEGAS NV
89128-0424
US

IV. Provider business mailing address

2704 N TENAYA WAY STE 1100
LAS VEGAS NV
89128-0424
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-5199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29013
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: