Healthcare Provider Details

I. General information

NPI: 1619390986
Provider Name (Legal Business Name): LINUS MUBUIFOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SHADOW LN 106
LAS VEGAS NV
89106-4363
US

IV. Provider business mailing address

400 SHADOW LN 106
LAS VEGAS NV
89106-4363
US

V. Phone/Fax

Practice location:
  • Phone: 702-759-0702
  • Fax:
Mailing address:
  • Phone: 702-759-0702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN 69090
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: