Healthcare Provider Details

I. General information

NPI: 1023443561
Provider Name (Legal Business Name): UNSOM MULTISPECIALITY GROUP PRACTICE SOUTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 W CHARLESTON BLVD SUITE 202A
LAS VEGAS NV
89102-2227
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD SUITE 215
LAS VEGAS NV
89102-2325
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-6475
  • Fax: 702-671-6440
Mailing address:
  • Phone: 702-671-2395
  • Fax: 702-382-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM A ZAMBONI
Title or Position: PRESIDENT
Credential: MD
Phone: 702-671-2222