Healthcare Provider Details

I. General information

NPI: 1134122021
Provider Name (Legal Business Name): NEVADA CARDIOLOGY PROFESSIONAL ASSN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 S MARYLAND PKWY STE 512
LAS VEGAS NV
89109-2310
US

IV. Provider business mailing address

3121 S MARYLAND PKWY STE 512
LAS VEGAS NV
89109-2310
US

V. Phone/Fax

Practice location:
  • Phone: 702-796-7150
  • Fax: 702-796-9071
Mailing address:
  • Phone: 702-796-7150
  • Fax: 702-796-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number175317600
License Number StateNV

VIII. Authorized Official

Name: PETRA SALYER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 702-233-1000