Healthcare Provider Details

I. General information

NPI: 1679201255
Provider Name (Legal Business Name): ALLISTER KIM RAMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 N TOWN CENTER DR
LAS VEGAS NV
89144-6367
US

IV. Provider business mailing address

800 VINCENT WAY
LAS VEGAS NV
89145-6161
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-7000
  • Fax:
Mailing address:
  • Phone: 323-829-1733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN85974
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: