Healthcare Provider Details

I. General information

NPI: 1053696245
Provider Name (Legal Business Name): NEVADA PHYSICIANS SPECIALISTS TOY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 S EASTERN AVE
LAS VEGAS NV
89119-5102
US

IV. Provider business mailing address

624 S TONOPAH DR
LAS VEGAS NV
89106-4029
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-9100
  • Fax: 702-685-9922
Mailing address:
  • Phone: 702-463-9100
  • Fax: 702-685-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN TRANQUILLO
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-463-9100