Healthcare Provider Details

I. General information

NPI: 1336920727
Provider Name (Legal Business Name): MITCHEL PHILLIPS DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5970 S RAINBOW BLVD
LAS VEGAS NV
89118
US

IV. Provider business mailing address

5970 S RAINBOW BLVD
LAS VEGAS NV
89118
US

V. Phone/Fax

Practice location:
  • Phone: 702-363-4000
  • Fax:
Mailing address:
  • Phone: 702-362-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GINA ONOFRE
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-362-0210