Healthcare Provider Details

I. General information

NPI: 1811186646
Provider Name (Legal Business Name): MAI T. VUONG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4488 S PECOS RD
LAS VEGAS NV
89121-5030
US

IV. Provider business mailing address

4488 S PECOS RD
LAS VEGAS NV
89121
US

V. Phone/Fax

Practice location:
  • Phone: 702-462-7901
  • Fax: 760-477-2929
Mailing address:
  • Phone: 702-462-7901
  • Fax: 760-477-2929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA933
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: