Healthcare Provider Details

I. General information

NPI: 1073783155
Provider Name (Legal Business Name): UNIVERSITY OF NEVADA SCHOOL OF MEDICINE MUTI SPECIALTY GROUP PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W CHARLESTON BLVD 610
LAS VEGAS NV
89102-2325
US

IV. Provider business mailing address

PO BOX 98528
LAS VEGAS NV
89193-8528
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-5089
  • Fax: 702-671-5197
Mailing address:
  • Phone: 702-671-6423
  • Fax: 702-671-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number
License Number StateNV

VIII. Authorized Official

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