Healthcare Provider Details

I. General information

NPI: 1841377157
Provider Name (Legal Business Name): OSTEOPATHIC MEDICAL ASSOCIATES OF NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 W SAHARA AVE
LAS VEGAS NV
89146-3307
US

IV. Provider business mailing address

5410 W SAHARA AVE
LAS VEGAS NV
89146-3307
US

V. Phone/Fax

Practice location:
  • Phone: 702-362-2500
  • Fax: 702-876-6581
Mailing address:
  • Phone: 702-362-2500
  • Fax: 702-876-6581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEAH TWIST
Title or Position: CREDENTIALING
Credential:
Phone: 702-362-2500