Healthcare Provider Details

I. General information

NPI: 1447576111
Provider Name (Legal Business Name): UNIVERSITY OF NV SCHOOL OF MEDICINE MULTI-SPECIALTY GROUP PRACTICE SO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W CHARLESTON BLVD 200
LAS VEGAS NV
89102-2351
US

IV. Provider business mailing address

1707 W CHARLESTON BLVD 200
LAS VEGAS NV
89102-2351
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-6475
  • Fax: 702-671-5090
Mailing address:
  • Phone: 702-671-6475
  • Fax: 702-671-5090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberPY0320
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number9126
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number7733
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7733
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7611
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12160
License Number StateNV
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9126
License Number StateNV
# 8
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPY0320
License Number StateNV
# 9
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number12160
License Number StateNV
# 10
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberPY320
License Number StateNV
# 11
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number7611
License Number StateNV

VIII. Authorized Official

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