Healthcare Provider Details

I. General information

NPI: 1386896835
Provider Name (Legal Business Name): UNIVERSITY OF NV SCHOOL OF MEDICINE MUTLI SPECIALTY GROUP PRACTICE SO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1391 S JONES BLVD
LAS VEGAS NV
89146-1200
US

IV. Provider business mailing address

PO BOX 98528 DEPT 401
LAS VEGAS NV
89193-8528
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-6200
  • Fax: 702-486-6368
Mailing address:
  • Phone: 702-671-2395
  • Fax: 702-382-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number10440
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN00227
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8762
License Number StateNV

VIII. Authorized Official

Name: DR. WILLIAM A. ZAMBONI
Title or Position: PRESIDENT
Credential: MD
Phone: 702-671-2278