Healthcare Provider Details

I. General information

NPI: 1134568074
Provider Name (Legal Business Name): FAYLONA, GOLLARD, KAUSHAL, NYAMUSWA & PARK LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N TENAYA WAY STE 200
LAS VEGAS NV
89128-0443
US

IV. Provider business mailing address

2460 W HORIZON RIDGE PKWY
HENDERSON NV
89052-2648
US

V. Phone/Fax

Practice location:
  • Phone: 702-822-2000
  • Fax: 702-938-2237
Mailing address:
  • Phone: 702-822-2000
  • Fax: 702-938-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL GOLLARD
Title or Position: PHYSICIAN/PARTNER
Credential: MD
Phone: 702-822-2000